Sentencing

The Earl of Longford: asked Her Majesty's Government:
	What steps they are taking to introduce new procedures for the fixing of tariffs for all those sentenced to detention during Her Majesty's pleasure; and whether they will give an undertaking that legislation will be introduced within six months of the judgment in the European Court of Human Rights in the case of Thompson and Venables.

Lord Bassam of Brighton: My Lords, the Government are currently considering the judgment of the European Court of Human Rights in this case. We shall, of course, announce our intentions as soon as we practicably can.

The Earl of Longford: My Lords, I hope my noble friend the Minister will forgive me if I say that that was the Answer I expected. I expected him to duck it. However, does he agree that the crucial issue is whether, in future, in the case of young offenders--that is, young people who are convicted of crimes that merit life sentences--the decision should rest with judges rather than the Home Secretary? Is my noble friend ready to say anything helpful about that?

Lord Bassam of Brighton: My Lords, my view is that we must consider the implications of this case very carefully. Of course, the ECHR judgment will have a strong bearing on the question of the treatment of juveniles in the future. It will have a tremendous bearing and effect on the treatment of juvenile offenders who are processed through the Crown Court system. That is one of the most complex issues at the heart of the matter.

Lord Goodhart: My Lords, in the case of very young children who are sentenced during Her Majesty's pleasure, does the Minister accept that what is appropriate is not so much a fixed term as a sentence which is dependent on the moral and psychological development of those young people?

Lord Bassam of Brighton: My Lords, the noble Lord speaks with great wisdom on this point; indeed, that is something very much at the heart of these issues. But the judiciary must take into account the seriousness of the crimes involved. This was a very serious crime and the court must take that very firmly into consideration, as well as the feelings of the public, witnesses and victims.

European Defence Initiative

Lord Blaker: asked Her Majesty's Government:
	What steps they are taking to give effect to the European defence initiative.

Baroness Symons of Vernham Dean: My Lords, the Government are actively pursuing discussions with EU partners on the commitment made at Helsinki to strengthen military capabilities. This will mean that EU nations will be better able to assemble, deploy and sustain effective forces for NATO or EU-led operations. We are also taking forward discussions on the political and military structures necessary for the EU, where NATO as a whole is not engaged, to decide and act in response to crises. All these matters will be taken forward under the Portuguese presidency of the EU.

Lord Blaker: My Lords, does the Minister agree that for the European defence initiative to be successful it is essential that it should enjoy the confidence of our American allies? Do not our American allies see at the moment that too many of our ships are in port or subject to speed limits because of a shortage of fuel; that too many of our aircraft are grounded because of a shortage of spares; and that too many of our soldiers are unable to communicate because their radios do not work? On top to all that, the Government are planning further defence cuts. Can we expect the Americans to have confidence in the situation, bearing in mind also the fact that the level of defence spending of our European partners is, in general, lower than ours?

Baroness Symons of Vernham Dean: My Lords, the noble Lord adroitly raised a huge range of issues in his supplementary question. On the question of some of the issues that have been aired in recent newspaper reports, perhaps I may point out that there is a good deal of exaggeration in what has been said regarding such matters as speed limits. There have been problems over the Clansman radio and a number of other issues which I would be very happy to discuss with the noble Lord if he wishes.
	However, the central point of the noble Lord's question is whether the Americans would have confidence in what we are taking forward. Perhaps I may tell him what Strobe Talbott, the US Deputy Secretary of State, said about these ideas on 15th December last. He said:
	"There should be no confusion about America's position on the need for a stronger Europe. We are not against; we are not ambivalent; we are not anxious; we are for it. We want to see a Europe that can act effectively through the Alliance or, if NATO is not engaged, on its own. Period. End of debate".
	There is no doubt in the minds of the Americans that we are taking forward a matter both properly and rightly.

Lord Hardy of Wath: My Lords, despite the matters to which the noble Lord drew attention a few moments ago, does my noble friend the Minister accept that the military capacity of the United Kingdom remains far more significant than that of any other member state of the EU and NATO in Europe? Can my noble friend say whether it is appropriate at this stage for consideration to be given in Parliament at Westminster to the future political structures of defence organisations in Europe, not least in regard to the future of the Western European Union and its parliamentary assembly?

Baroness Symons of Vernham Dean: My Lords, of course I believe that the United Kingdom's military capacity is very considerable and certainly very significant within Europe. I do not think that we need to look any further than the recent engagement in Kosovo. I know that many noble Lords will have heard what General Sir Mike Jackson had to say on this issue when he was recently interviewed during a radio programme. He said:
	"I look back and just recall ... the entry into Kosovo by KFOR ... the record speaks for itself. It was a considerable success".
	That was a considerable success to which the United Kingdom contributed in no small measure. None of us should forget that fact.
	The Kosovo crisis also underlined the need for European nations to make a greater contribution to their own security. It is right that Europe should have a place on the international stage that matches its economic and political weight. It is the matching of that considerable political and economic weight that Her Majesty's Government seek to progress in taking forward these discussions on the European defence identity.

Lord Chalfont: My Lords, can the Minister tell the House whether the implementation of this initiative will require any additional British troops and, if so, how many? What will be the cost? Are there any implications for the already serious over-stretch of the British Armed Forces?

Baroness Symons of Vernham Dean: My Lords, obviously we are looking at all these questions carefully. As I indicated in my initial Answer to the noble Lord, Lord Blaker, these matters will be discussed under the Portuguese presidency. Over the next few months we shall have to consider not only what we in this country are doing but also what our allies are doing.
	The European nations will certainly need to spend defence budgets more effectively; I think that we can say that without fear of contradiction. Just as the UK has done in our Strategic Defence Review, our European partners will need to review the structures of their Armed Forces. But, of course, we shall also have to consider the implications of that for our own Armed Forces and also the cost implications. I am afraid that it is too early for me to give a detailed answer to the points on cost that the noble Lord, Lord Chalfont, raises, but I assure him that they are very much in the forefront of our minds as we consider this question.

Lord Shore of Stepney: My Lords, I am sure my noble friend is aware of the importance of nuances in this question of a separate European defence identity. But surely I am right in recalling that Strobe Talbott, whom my noble friend quoted at some length, referred in that passage particularly to the need for Europe as a whole, as it were, to strengthen the European side of the alliance. He went on to say, if my memory is correct, that he was concerned at the possibility of an autonomous European defence force growing away from the main body of NATO. Surely if I am correct about that, it puts a very different interpretation upon his speech.

Baroness Symons of Vernham Dean: My Lords, we have repeatedly made it clear--and I have made it clear on innumerable occasions from this Dispatch Box in your Lordships' House--that NATO remains the cornerstone of the United Kingdom's defence policy. Nothing I have said today should in any way derogate from that principal undertaking. The noble Lord returns to what Strobe Talbott said. I quote the passage again, specifically as it relates to Helsinki where the headline goal specifies that,
	"[when] co-operating voluntarily in EU-led operations, Member States must be able, by 2003, to deploy within 60 days and sustain for at least 1 year military forces of up to 50,000-60,000 persons capable of the full range of Petersberg tasks".
	I repeat that that was the Helsinki headline goal.
	I quote directly the words of Mr Strobe Talbott:
	"Helsinki represented, from our perspective, a step--indeed, several steps--in the right direction".
	I do not think that there is any doubt about what our American colleagues feel on this issue.

Lord Hooson: My Lords, does not the noble Baroness agree--but perhaps she is too young to remember this--that the late President Kennedy often spoke of the two pillars of NATO: the North American pillar and the European pillar? Is it not correct that until now we have singularly failed in Europe to build that pillar? Is not this new initiative long overdue?

Baroness Symons of Vernham Dean: My Lords, I do not think that we have singularly failed to develop that pillar. I think that that is taking the argument a little further than we on this side of the House are prepared to do. As I have already indicated, I believe that Kosovo showed that the European alliance, the EU, can act on occasions when our American colleagues choose not to do so. Although I am not, sadly, quite as young as the noble Lord would like to imply, it is quite clear that the American view on this matter does not come simply from the current administration. I quote from a Republican source, Mr Robert Zoellick, a key adviser to George W Bush, who said that,
	"Congress is far more likely to support a US presence in Europe if the EU is a full partner".
	I believe that we have seen on the part of key players on both sides of the American divide that the Americans are in support of what we are trying to do. I refer to the initiative in which the Prime Minister has been a key player and a key initiator.

Lord Mackie of Benshie: My Lords, does the noble Baroness agree that integration might give much better value for the money spent all over Europe?

Baroness Symons of Vernham Dean: My Lords, I did not hear what would give better value for money.

Lord Mackie of Benshie: Integration; in other words, when companies merge they normally intend to save money. In this case integration of defence in Europe should give better value. Does she agree?

Baroness Symons of Vernham Dean: My Lords, integration raises a whole range of other questions. We would wish to ensure that on this issue we move at a pace that is comfortable for all our allies. Everyone will know, for example, that for operational purposes our French colleagues are not as integrated into the NATO alliance as we are. It is important to bear in mind that all nations involved in NATO will want to ensure that the particular feelings and worries that they may have are properly taken into account. This is not a process over which we can wave a magic wand and that it will all come right overnight.
	Over the coming months, under the Portuguese presidency, we shall have to look at the detailed arrangements, for example, for the participation of non-EU European allies, and we shall have to devise arrangements for EU and NATO relations. These are all difficult questions but they are ones to which we should now turn our minds.

Earl Attlee: My Lords, how will the Minister achieve convergence of EU defence expenditure?

Baroness Symons of Vernham Dean: My Lords, I am happy to say that that is not necessarily a question entirely for me to answer. Over the next few months, under the presidency of our Portuguese allies, we shall be considering how to focus on the capabilities in order to define the headline goal that I detailed to your Lordships a moment or two ago. It is important that we look at what we are trying to achieve.
	We are all aware that there are different levels of expenditure among our EU allies. I am sure that questions about levels of expenditure should be given a great deal of consideration. But it is very difficult to make the direct comparisons that we have seen recently in some of our newspapers. When one sees comparisons of relative expenditure across European countries, very often they do not compare like with like. One set of budgets will be dealing with a range of issues which are not comprehended in another set of budgets. Your Lordships should treat with very great caution the kinds of figures that we have seen in our newspapers.

The Earl of Sandwich: My Lords, can the Minister confirm that one of the primary purposes of defence in Europe these days is humanitarian? If that is the case, what consequences does it have for recruitment?

Baroness Symons of Vernham Dean: My Lords, much of what we have dealt with recently have been humanitarian exercises. The noble Earl will be aware that the Strategic Defence Review concentrated very considerably on peacekeeping exercises and on conflict prevention. Recruitment--which I think was the question raised by the noble Earl--is running very well at the moment, particularly in the Army. The last calendar year was the best year for recruitment in the Army for some 10 years or so. The young people joining our Armed Forces today are in no way put off by the humanitarian emphasis in what they will be asked to do. Rather, I think that there is considerable enthusiasm among young people in this country for the kind of tasks that they will be asked to undertake in Her Majesty's Armed Forces.

Lord Stoddart of Swindon: My Lords, is my noble friend aware that there is puzzlement among some people as to exactly what the new European army will do? NATO is the defence organisation which has protected Europe and intervened in conflicts in Europe over a long period of time. Can my noble friend say what will be a European issue and a European conflict and what will be a European Union interest and a European Union conflict? Or will the European Union army be responsible for the whole of Europe, wherever it extends?

Baroness Symons of Vernham Dean: My Lords, I regret to say that the puzzlement is not so much in the minds of young people or others looking at this matter but is a basic confusion in the mind of the noble Lord, Lord Stoddart. We are not creating a standing European army. I have repeated that on many occasions when speaking from this Dispatch Box on behalf of both the Ministry of Defence and the Foreign Office. I do so again. We are not creating a standing European army or a standing European rapid reaction force. We have made that clear. We have also made clear that we are not prepared to relinquish national control of our Armed Forces. I cannot think of a more unequivocal way of putting that. It is, to me, absolutely crystal clear. I hope that now it will be crystal clear to the noble Lord, Lord Stoddart.

Mixed-sex Wards

Baroness Seccombe: asked Her Majesty's Government:
	Why the target of eliminating mixed-sex wards in 70 per cent of health authorities by December 1999 was not achieved.

Lord Hunt of Kings Heath: My Lords, as I said in the House last week, we are committed to ensuring that mixed-sex accommodation disappears and we are working towards that. To achieve this aim we have put in place the target that 95 per cent of health authorities will have eliminated such accommodation by the end of 2002. I regret and apologise to the House for implying last week that the target was 100 per cent. However, in practical terms, our intention is that almost all mixed-sex accommodation will disappear. There are five trusts where capital schemes will come to fruition after 2002. In those few cases the feasibility of building temporary segregated washing and toilet facilities is being actively explored.

Baroness Seccombe: My Lords, I thank the Minister for that disturbing and disappointing Answer. Is it really beyond the collective wit of the Government and the health administrators to deal with the problem? It is not just about money; it is a question of political will. The same promise was made two years ago: to deal with the problem. Why have not the Government delivered on it? If the promise is not delivered, why should anyone believe the Government in relation to the NHS?
	I quoted from a question asked by the then Leader of the Opposition to the Leader of the Government. That was in 1996. It is disturbing that we are still in this position.

Lord Hunt of Kings Heath: My Lords, as the noble Baroness will know, in 1995 her government introduced in the Patient's Charter the right of the patient to know before going into hospital whether he or she would be placed in mixed-sex accommodation. But her government did nothing further to monitor that or to set targets for the health service. We have done so. As I said, we are committed to ensuring that 95 per cent of health authorities meet the target by the end of 2002; and we are in discussions with those five trusts which have capital schemes that will come on stream after that date to see whether it is feasible to introduce temporary separate facilities.
	I understand the concerns of your Lordships and many members of the public about the disturbing effects of mixed-sex accommodation in many of our hospitals. I understand the urgency with which your Lordships wish this problem to be tackled. I assure the House that the Government are determined to ensure that the target is achieved.

Lord Stoddart of Swindon: My Lords, is the Minister aware that in the last Parliament I promoted a Bill in this House to phase out mixed-sex wards? Indeed, the House was good enough to approve that Bill and to pass it to another place. Is my noble friend further aware that my noble friend Lady Jay, the previous Secretary of State, Frank Dobson, and the noble Baroness, Lady Cumberlege, are fully and utterly committed to the policy of getting rid of mixed-sex wards? They should be commended for that. I believe--I hope that my noble friend will be able to deny this--that they are being undermined by the authorities in the hospitals themselves. Frankly, that is completely and utterly unacceptable, not only to the public at large but to Members of this House and of another place who have said repeatedly that they want mixed-sex wards phased out. I hope that my noble friend will redouble his efforts to ensure that we reach his target date of 2002, which he announced last week.

Lord Hunt of Kings Heath: My Lords, first, perhaps I may pay tribute to my noble friend and to other noble Lords for their determined campaigns over the years in this area. As I have said before, this issue unites the whole House. I am not sure that the word "undermine" is appropriate in relation to the progress being made by health authorities. However, I am disappointed with the progress that has been made so far. That is why we are redoubling our efforts to monitor the situation and to make clear to the NHS that we are absolutely determined to ensure that the 95 per cent target is adhered to. Furthermore, I assure my noble friend that performance management throughout the next two to three years will ensure that that is done.

Baroness Strange: My Lords, is the Minister aware that, despite appearances, we on these Benches--and on the Bench in front--are not making a statement about the Question, although we should like so to do?

Lord Hunt of Kings Heath: My Lords, I am sure that those are words of wisdom which I shall take away.

Lord Naseby: My Lords, exactly how will the Minister ensure that his aspirations in this field will be successful when they have not been met on matters such as waiting lists and a further host of areas within the health service? Will they be achieved by exhortation or by money? How will he ensure that the 95 per cent target will be met by 2002?

Lord Hunt of Kings Heath: My Lords, I am disappointed that the noble Lord thinks that the Government have been unsuccessful. However, I believe that we are making considerable progress in the modernisation of the National Health Service. Thirty-seven new hospitals are on track. New services such as NHS Direct have been set up. In-patient waiting lists are now 87,000 lower than those we inherited and a third of a million more people are being treated as out-patients this year. These are significant steps along the way to modernisation. As regards achieving the 95 per cent target, we have in place strong and effective performance management arrangements. We have made it absolutely clear to regional chairs and directors of the NHS that we want this commitment to be brought to fruition.

Lord McColl of Dulwich: My Lords, have I understood the Minister correctly? The Government will have been in power for five years before they meet their target. However, when the noble Baroness the Lord Privy Seal was Minister of Health, she said on 5th August 1997 that,
	"Any health authority which tells me that it is unable to get rid of mixed sex accommodation within the next two years will have to have a very good reason".
	Can the Minister explain the difference in the timetable?

Lord Hunt of Kings Heath: My Lords, the noble Lord's Government had 18 years in which to sort this matter out. The fact is that my noble friend did take a very active interest in ensuring that the health service removed mixed sex accommodation. I have already said that I am disappointed--as, I am sure, is my noble friend--that health authorities have not made the progress that we would have wanted. Because of that, we are redoubling our efforts to ensure that the 95 per cent target at end-2002 is achieved.

Lord Harris of Haringey: My Lords, I am sure that the House is grateful for my noble friend's reaffirmation of the target and assurances that progress is being made. Is it not the case that in many hospitals progress has already been made by the creation of single sex bays rather than single sex wards? While we all wish to see a situation where all wards rather than bays are single sex, can my noble friend confirm that the 95 per cent target has been set for wards rather than bays? That will clearly represent significant progress over what has already been achieved.

Lord Hunt of Kings Heath: My Lords, the target is set for accommodation. It is, of course, perfectly acceptable for segregation to be achieved in wards that accommodate both men and women through the use of single sex bays and individual rooms. I should make it clear that the definition of mixed sex accommodation is exactly the same as that used by the previous government in the Patient's Charter. My noble friend is right. New building techniques can ensure that, within a ward with separate bays, it is possible to provide strong segregation between those bays.

Lord Clement-Jones: My Lords, in view of the Government's performance in this area, and the events of the past two weeks, can the Minister confirm that the Government's pledges for the NHS are now being converted from commitments to mere aspirations?

Lord Hunt of Kings Heath: My Lords, this Government made a commitment to modernise the NHS. We are doing so. I repeat my reference to 37 hospitals, NHS Direct and new dental services. These are indications of the kind of health service that we wish to deliver and which we will deliver.

Lord Campbell of Croy: My Lords, can the noble Lord tell the House whether progress is being impeded by the chronic and continuing shortage of nursing staff? Could that be the reason for the problems in this area?

Lord Hunt of Kings Heath: My Lords, I invite all noble Lords to remain in their places for our debate on nursing staff that will begin in a few moments. Of course we are crucially dependent on nurses. However, our recruitment drive is proving to be successful and over 5,000 nurses are about to return to the NHS as a result of it. I believe that the appointment of nurse consultants and the decision of the Government not to stage pay awards but rather to pay nurses the awards recommended by the review body in full will ensure that we shall have the nurses we need to provide the services to which the noble Lord referred.

Electronic Communications Bill

Brought from the Commons; read a first time, and to be printed.

Nursing Education and Practice

Baroness McFarlane of Llandaff: rose to call attention to the state of nursing education and practice; and to move for Papers.
	My Lords, it is a privilege to be the opening speaker in the first debate of the day, knowing that it will be closely followed by a debate on the teaching profession. Thus in one day we shall deal with two of the professions that contribute so much to our society: nursing and teaching, and which help us to express the values that we hold about health and education.
	Perhaps I may begin by saying that the debate in my name owes its inspiration to the noble Lord, Lord Morris of Castle Morris, who, well before the Summer Recess, was urging on some of us the need for a debate on nursing. When he was unable to table the debate in his own name, he delegated the responsibility to others. This debate is the result of our discussions. However, I am sure that we are all delighted to see the noble Lord, Lord Morris, in his place today to contribute to the debate. It is a tribute to the standing in which he places the nursing profession and the affection that he holds for it that he is here today. We look forward to his contribution with great expectation, knowing that his analysis will be even more incisive because of his personal experience.
	I believe it right that we should congratulate the Government--as the Minister has already done himself--on their moves on recruitment of nurses and attracting nurses back into the profession. Those moves will go a long way to ameliorating some of the shortages. The profession is gratified by the pay award made last week, in particular that made to the clinical nurse specialists. However, as has already been said during Question Time, there are still a number of shortages; namely, an estimated shortage of 17,000 nurses which inevitably has an impact on the practice of nursing and nursing education.
	We now look forward to the Government being able to deliver on their strategic aims, expressed in Working Together--Securing a Quality Workforce for the NHS; that is, we want to ensure that we have a quality workforce in the right numbers, with the right skills and diversities, organised in the right way, and to be able to demonstrate that we are improving the quality of working life for staff.
	Nursing makes an extremely important contribution to the health service both by virtue of the nature of the care that nurses give and by virtue of the numbers of nurses. There is a growing body of international research that attests to the fact that the therapeutic contribution made by nurses is considerable. Effective nursing care reduces the period of hospital stay. It reduces the incidence of hospital infection. It reduces re-admission rates. So the contribution of nurses is extremely important as regards many aspects. As of July 1999 there were 332,200 whole time equivalent nursing, midwifery and health visiting staff employed in the NHS, three-quarters of whom were qualified.
	Nursing practice takes place within the context of a rapidly changing health service. It is not surprising that the content and mode of nursing education needs to be repeatedly reviewed if it is to prepare practitioners for a modern health service. We are used to reports on nursing education emerging at intervals of roughly 10 years. There was Platt in the 1960s, Briggs in the 1970s, Judge in the 1980s, followed by Project 2000. We sometimes tend to forget the criticisms of previous systems of nursing education and wish to return to the past. It was recognised when Project 2000 was put forward that the training previously given tended to be procedure-based and hence rather rigid, though there were hospital schools of nursing with excellent educational programmes. But the nurse of the future needs to be able to practise in the context of rapid changes in medicine, the input of pharmaceutical advances, the changes in advanced technology, the increased use of information technology and a greater concentration of services in primary healthcare. In the modern health service nurses need to have a high degree of technical competence and scientific skills, but those need to be exercised alongside the caring and nurturing role traditionally associated with nursing. There is an increasing development of nurse-led services. We have already heard of NHS Direct. There is also a blurring of professional boundaries, with many medical tasks now being taken on by nurses.
	Project 2000 courses were designed to offer a common foundation programme and hence provide for greater flexibility between the different branches of nursing and to prepare nurses who would be able to work in a variety of settings. They aimed to give an adequate knowledge base of biological and behavioural sciences for the practice of nursing. They were to be based in the higher education sector alongside other health professionals being educated there, where the knowledge taught would be research-based. The object was to produce a knowledgeable, adaptable practitioner who would work from an evidence base.
	Project 2000 courses have now been running for approximately 10 years, so it is timely to review their progress. A number of reports have been issued in the past year, which help us to look at the present state of nursing and nursing education. Nurses are now educated in 89 universities in the UK. There are 47,000 nursing students and 5,000 nursing, midwifery and health visiting lecturers. Therefore, the higher education sector now has a considerable stake in nursing education.
	While a great deal has been achieved by Project 2000 programmes, there are concerns about the clinical competence of some of the new graduates and diplomates. While 50 per cent of the course is spent in learning practical skills, the way in which practice placements are organised, their quality and the supervision of clinical practice, gives cause for concern. Because of the quick turnover of patients, there are relatively few acute care situations where students can consolidate practice skills and nurse a patient over any length of time. There is a shortage of trained staff on most hospital wards who can spare the time to supervise student nurses. Ideally, the university lecturer should teach in the clinical situation where she can integrate theory and practice. A number of different approaches to enable university lecturers to do this have been tried. Roles like honorary appointments, joint appointments between the health service and the higher education sector, clinical lectureships and clinical nurse specialists have been tried. There is now a suggestion that there should be clinical deans. A clinical academic career structure is desperately needed if nurses are adequately to integrate theory and practice. There is a need for partnership between the education consortia and the universities in facilitating teaching through a device such as SIFT--Service Increment For Teaching--that is awarded in medical education.
	The academic content of the higher education programmes needs to be reviewed from time to time. Some schools of nursing may be more felicitously placed in universities where the necessary sciences are to be found and a nursing course can call on the whole expertise of the university in the true spirit of a university. However, there are signs in some courses of "academic drift". One can find a rationale for including almost any piece of theory in a course if one looks for it. But academic drift is not exclusive to nursing courses. I have sat in meetings of my own medical faculty at Manchester University and listened to discussions about academic drift in the medical curriculum. This is something that academic courses, particularly professional academic courses, have to watch carefully. They need to guard the content of their programmes. Universities need to produce a practitioner of nursing suited to work in the present NHS.
	Perhaps I may declare my personal interest because until I retired 12 years ago I was professor of nursing at Manchester University. We pioneered a course there which included preparation not only for practice in acute settings but in primary care settings. The graduates came out with qualifications as a registered nurse, a district nurse and a health visitor. Yesterday I learnt that that course is now under question because it is a four-year course instead of a three-year course. Yet that course is producing people who are eminently suited to the modern NHS. At the moment, they come out with qualifications in acute nursing but also specialist qualifications in home nursing, public health nursing and/or community psychiatric nursing. These are people whom employers desperately need and value.
	It is essential that the universities and the registering bodies look at the practitioner who is suited to the present work in the NHS. Equally, it is essential that NHS trusts resource the training of the future workforce. I particularly commend the recent report, Good Practice in the Recruitment and Retention of Nurses, published by the NHS Executive and the Committee of Vice-Chancellors and Principals.
	I know that other speakers in the debate will refer to the widening of access to higher education which is taking place through university courses. I wish to refer to the fact that the Government have even more radical plans for the future of the professions in general and the nursing profession in particular. In their second report on the future healthcare workforce, the Government point to future multi-professional and inter-professional healthcare delivery. They envisage a healthcare practitioner role, which would embrace much of the current roles of junior doctors, nurses, therapy professions and radiographers. How will that affect the future education of the professions and their self-regulation, about which we have been given so many assurances? My noble friend Lady Emerton will refer to the whole question of regulation.
	In the final minute of my speech, perhaps I may indulge in a personal note. This year I had the pleasure of attending the Lord Mayor's Show on the float of the League of St Bartholomew's Hospital Nurses and for the first time rode in an open horse carriage through the City of London. A tremendous cheer went up every time the nurses came into view. Then the president of the league, in stentorian tones as she was dressed as the matron of 100 years ago, proclaimed, "I am the matron of St Bartholomew's Hospital". With that, the crowd erupted. I believe that the public and nurses wish to see an identifiable leader of the nursing service. We need that desperately in the face of all that has happened as regards general management. My Lords, I beg to move for Papers.

Baroness Lockwood: My Lords, I am grateful to the noble Baroness, Lady McFarlane, for opening this debate and in so doing drawing on her vast experience in the nursing profession. I should also like to join her in welcoming my noble friend Lord Morris of Castle Morris back to his place. I look forward to his speech, no doubt crafted from his hospital bed.
	Today's debate is not about short-term crises. It is about a long-term policy and programme for education and training in the nursing profession. It is about creating the right terms and conditions under which nursing can flourish as a career profession. Most of us at some time in our lives have had experience of nurses, largely associated with hospitals, although today there is a much larger canvas on which nurses can work. I certainly have a perception of nurses as being very professional. Yet so far we have not produced the right framework for this profession to be sufficiently recognised and rewarded.
	My interest in the debate stems from my Chancellorship of the University of Bradford. It has a very successful School of Health Studies which works in co-operation with all the local health service trusts. In a recent quality assessment review in teaching, I am delighted to say that the Bradford school received two "excellents", covering seven departments, including nursing and midwifery. We are proud of the contribution that we are making to improving the quality of university education in nursing.
	Like most schools of health studies, Bradford provides both pre-registration diploma and degree courses and post-registration courses at diploma, degree and Masters level. Nationally, about 90 per cent of pre-registration courses are at diploma level and about 10 per cent at degree level. Unfortunately, the attrition rate for nursing and midwifery is about 30 per cent, which is much higher than the average drop-out of undergraduates in higher education. For Bradford, I am pleased to say that, at 24 per cent, it is below the national average. Even so, that is still too high.
	The dilemma of universities is in balancing recruitment, with good A-level scores to boost their academic profile and provide greater research potential, against widening access. There is also the anomaly that students on diploma programmes get a non-means tested bursary whereas degree level students get a means tested bursary. For universities and students alike, this gives an advantage to the diploma courses.
	Universities also complain that a limiting factor in increasing recruitment is the availability of suitable clinical placements, mentors and assessors. On the service side, hospitals and other National Health Service trusts also have a problem of attrition. They see one answer to that as local recruitment and the building up of local loyalties. Their need is a stable workforce, with a stream of newly qualified registered nurses being sufficiently experienced clinically to undertake the responsible tasks that nurses have to perform.
	It was to deal with this type of problem and the possible conflict of interest that the Peach Commission was set up. Its report, Fitness for Practice, with its 33 recommendations, together with the earlier government publication, Making a Difference, provide the basis for current reform. I want to mention just four of the Peach recommendations which are crucial to future development.
	First, it recommended a flexible approach to recruitment. In this, the commission recognised that recruitment will continue to be at different ages and from different backgrounds, with different levels of academic and vocational qualifications. Therefore, it placed an emphasis on access programmes, on prior experiential learning experience and modular studies, with flexible step on and step off courses. Secondly, it recommended that built into the flexible recruitment should be an expansion of graduate courses, because of the nature of clinical decisions that have to be made in complex situations, as the noble Baroness, Lady McFarlane, explained, and to compete with other graduate professions as the participation rate in higher education grows.
	Thirdly, the commission recommended pre-registration courses, to be made up of 50 per cent theoretical and 50 per cent practical learning. Most of us would expect that in training, but it will provide a real challenge, especially to the NHS trusts. Fourthly, the commission recommended the provision of career progression in nursing, with appropriate professional training at all levels. The commission recognised that some higher education institutions and National Health Service trusts are already ahead of others in carrying out some of the recommendations. The Government have set up some 15 sites representing a third of the consortia NHS/university partnerships to pilot new models of nurse education on a more flexible modular system.
	It is encouraging to see some of the things that are already happening. Here I have to rely on information from the Bradford National Health Service Hospital Trust, with which I have some association, regarding the strategies it is adopting in co-operation with the University of Bradford, Bradford College and other local education bodies, including schools and careers teachers.
	The trust is seeking to enrol local school-leavers into healthcare at various levels, and is particularly targeting different ethnic groups who do not see the health professions--apart from that of doctor--as suitable careers. Therefore, close links with schools and the establishment of a cadet scheme for 18 to 20 year-olds form part of the trust's approach. There is also a scheme to support young ethnic unemployed in an attempt to encourage them into clinical support work with the community health trusts while studying for a B.Tech. The scheme is a finalist in the National Health Service Equality Awards 2000. Young people on both those courses would qualify for entry to a university diploma course.
	Healthcare support workers already employed in the hospital trust who qualify academically are being seconded to nursing and midwifery courses at the university while retaining their basic salary and pension rights--a scheme funded by the West Yorkshire National Health Service/university consortia. I am sure that that is a great boon in retaining and improving the status of support workers.
	For those who do not meet the university entry requirements, an access course with the college is available. At postgraduate level there are other initiatives. As part of career development, an advanced diploma and degree modular course has been developed by the university and the trust to comply with the flexible approach in Fitness for Practice.
	The trust's framework document, Advancing Nursing Practice in Acute Care, was used by the university to develop new post-registration modules to align with trust strategy. Other new post-registration modules are being developed in cancer care, heart disease and co-rectal care which are commissioned by the regional consortia.
	That kind of collaboration does not happen by chance. It has continually to be worked at by all concerned in the education and training of nurses. But it does provide a more optimistic outlook for future patient care, at the same time enriching and providing progression in the nursing profession. Fitness for Practice, combined with the better salary awards in this and last year's nursing pay awards, must surely make a contribution to raising the profile and attractiveness of nursing as a career.

Baroness Cox: My Lords, it gives me great pleasure to take part in this debate introduced by the noble Baroness, Lady McFarlane. Although my own career has developed in strange ways, taking me far afield and away from an orthodox nursing career, I am and always will be a nurse first and foremost. It was my chosen profession until, while practising as a staff nurse, tuberculosis struck. After six months in hospital I had to move from clinical nursing into academic life.
	As a nurse, I remember the delight with which the profession received the news that Professor McFarlane had become the Baroness McFarlane of Llandaff--a very well-deserved recognition of personal professional achievements. The comprehensive way in which the noble Baroness introduced the debate reflects the qualities and abilities which made her nursing's first Peer.
	I shall focus primarily on nursing education because the quality of professional practice must, to a considerable extent, depend on the quality of professional education which prepares practitioners for their professional responsibilities. As part of an earlier incarnation, I was director of the nursing education research unit at London University. One of our major projects was concerned with student nurses' clinical learning; another with post-qualification education, or lack thereof, for the all-important role of ward sister or charge nurse.
	We identified many issues and problems. Subsequently, bodies such as the English National Board for Nursing, Midwifery and Health Visiting, the Royal College of Nursing and the UKCC have worked valiantly to try to address some of those problems. Perhaps I may say how good it is that the noble Baroness, Lady Emerton, is present, having done so much for nursing through her work on the UKCC.
	I turn first to recruitment. A good health service relies on its staff, especially perhaps its nursing staff, who are needed for round-the-clock care in diverse clinical settings. Despite measures taken in an attempt to improve recruitment, noble Lords will be well aware of the acute problems experienced by the NHS in recent weeks. Hospitals have been inundated with people suffering from 'flu. Some patients have had to lie in corridors; others have had to suffer the tragedy of deferred operations for malignant disease, with possibly life- threatening consequences, because of shortages of nursing staff, especially in areas such as intensive care.
	The problems are reflected in the recruitment figures. In England, the number of entries to pre-registration programmes fell from 17,799 in 1987-88 to 15,650 in 1997-98 and in Northern Ireland, from 811 to 459. The number of newly qualified entrants to the UKCC register fell from 32,143 in 1993-94 to a mere 26,465 in 1997-98.
	Once student nurses begin their professional education, other problems cause a significant number to leave before qualification. More leave when they encounter the stresses inherent in professional practice, including clinical responsibilities, for which many feel ill-prepared; anti-social shift hours; and relatively poor salary scales compared to other professions.
	Nursing's professional organisations have tried to remedy these problems. Nursing education has been transformed in recent decades with the transition to higher education. Emphasis has been placed on academic education, encouraging students to think critically and to adapt to a world where the pace of change in knowledge and practice is perpetually challenging.
	Perhaps I may refer to my own experience as a student nurse to illustrate the change in ethos in nurse education. At the end of my first ward placement I went nervously to discuss my ward report with "Sister"--a ward sister for whom I had profound respect. She was a superb clinician; she cared for patients and their families with great compassion and wisdom; and she was an excellent teacher and outstanding ward manager. I was profoundly relieved when she gave me a good report. However, as I was leaving her office, she called me back and gave me these parting warning words, "In your own interests, nurse, as you go through your training in this hospital, please do not ask so many awkward questions." I was a shy 18 year-old, unaware that I had asked any questions, let alone awkward ones. But such was the culture of nurse education at that time that students were meant to be passive learners and unthinking practitioners.
	Now, with nursing located in higher education, students are encouraged to think. That is essential, as professional education is essentially teleological. It must be judged by its effectiveness in preparing practitioners for their professional responsibilities. And there have never been greater responsibilities and opportunities for nursing. Many exciting initiatives have led to changes in the provision of healthcare which are both care-effective and cost-effective. I give just three instances: nurse-led clinics in primary healthcare which relieve busy GP clinics for consultations on a wide range of problems; clinical nurse specialists who provide highly effective, comprehensive care for patients with chronic diseases, such as asthma and diabetes; and hospital-at-home schemes which provide, for example, care for very sick children to enable them to stay at home and often avoid distressing admission to hospital.
	The enhanced role and responsibilities of nurses require appropriate education. Although the transfer to higher education provides the context for a higher level of academic education, which is obviously welcome, there are problems. In too many cases these include a lack of match between academic theory and clinical experience, inadequate supervision and support in the clinical area, inadequate systematic practice and assessment of core clinical competencies, and problems in finding appropriate clinical placements in fields of practice such as community care. The report of the UKCC's Education Commission, Fitness for Practice, published last September, cited evidence of inadequate clinical learning experiences, epitomised in the observation of a theatre sister that,
	"more clinical experience is required ... there appears to be an over-emphasis on the academic at the expense of clinical experience. A good nurse should be able to use her hands as well as her brain".
	Part of the problem of inadequate clinical training stems from the shortage of qualified staff on the wards or other clinical areas. There are just not enough experienced nurses available to take time from caring for patients in order to teach, supervise and support students. Thus, students may fail to learn good practice and inadvertently provide inferior or bad patient care. In such situations, not only patients but students suffer stress and anxiety, sometimes to such an extent that they leave.
	I shall never forget working on an acute medical ward with a student on her very first day. The staffing shortage was so severe that there were not enough nurses to provide that student with any support. She was given responsibility for some desperately ill patients, one in the terminal stages of a muscular degenerative disease and a cardiac patient who had already suffered four cardiac arrests that morning. While the student was trying to make the terminally ill man comfortable, the cardiac patient suffered another arrest. The resuscitation team rushed to the bedside to find that some of the equipment was not in place. The target of their wrath was the student nurse. By mid-morning she was in tears and ready to quit nursing for ever. I hope passionately that the initiatives now being taken to solve these problems, such as the UKCC's new competency approach to the pre-registration of students, will be implemented quickly for the sake of patients, students and the profession.
	I turn briefly to the retention of qualified staff. The problems take the form of a vicious circle. Too few new nurses enter the profession and shortages cause stress among practitioners who are unable to provide the quality of care they wish to give patients or provide adequate support to students. That stress leads to plummeting job satisfaction and a tendency to look outside nursing to alternative employment opportunities, often in better paid jobs. Therefore, one has premature retirement, further shortages and heightened stress for those who remain.
	While the recent salary increase is welcome, it is not a panacea. A percentage of a relatively low figure is still a small sum. Nursing salaries do not compare favourably with those of other professions. Working hours also compare unfavourably. Given the anti-social hours, disruption of family life, stressful working conditions and having to cope with life-and-death responsibilities, sometimes combined with the risk of physical assault, especially in areas such as accident and emergency or psychiatry, it is not surprising that nurses are tempted to leave for greener, more tranquil pastures. I urge the Minister to encourage the Government to do much more to address the problems of recruitment and retention.
	I conclude by emphasising that all is not gloom and doom, thanks largely to the calibre of the people who take up nursing and remain committed to the profession. In spite of all the stresses and strains, nursing brings many privileges and satisfactions, above all, the privilege of caring for people when they are most vulnerable. In his book Moderated Love: A Theology of Professional Care, the philosopher Alastair Campbell describes the essence of nursing as "skilled companionship". As a nurse it is a great privilege to be able to accompany another person on part of his journey through life when he experiences a crisis that necessitates the kind of care which nursing can give--not just "doing to" but "being with" another person in his hour of need. This is the heart of nursing. Nursing is a calling and profession that can give a reward, not financial but personal, that is beyond price. But for this companionship to be rewarding it must, in Campbell's words, be "skilled". That requires good professional education, which was where I began and where I finish.

Baroness Warwick of Undercliffe: My Lords, I join in thanking the noble Baroness, Lady McFarlane of Llandaff, for initiating this debate on nursing education. I also express my delight to see the noble Lord, Lord Morris. I wish him well. I declare an interest as Chief Executive of CVCP. Nurses are educated in 89 universities in the UK and it is to that specific aspect that I want to speak.
	I am pleased that we have moved on from the debate in early 1999 about whether there was value in better nursing education to the recognition of much of the excellent education that takes place in universities in partnership with the National Health Service. Universities are responsible for the education of all health professionals in the UK; they are essential to the delivery of skilled NHS staff. Much progress has been made since the publication last July of the Government's nursing strategy Making a Difference.
	I deal briefly with three points: the relationship between universities and the NHS, which has certainly been strengthened; more flexible career paths into nursing; and meeting the demand for high quality academic and practice-based nursing education. As to the strengthening of the links between the NHS and universities, in November 1999 the CVCP and NHS Executive held a joint conference to focus on improved working between the NHS and higher education. A partnership statement was issued which identified areas of mutual interest and responsibility, such as the recruitment and selection of students and the provision of high quality clinical placements and quality assurance. These shared principles ensure that health professionals are able to meet the country's present and future health and healthcare needs.
	I should like to look at some of the ways in which nursing education responds to the problem of recruitment identified by the noble Baroness, Lady Cox. New models of nursing education are being developed which will allow more flexible career paths into nursing and ensure that equality of opportunity and diversity are actively addressed. These include: entrance through new vocational pathways; more part-time education; and more stepping-on and stepping-off points. In November 1999 the CVCP and NHS Executive published a joint report entitled Good Practice in the Recruitment and Retention of Nurses in Higher Education Institutions. Its purpose was to disseminate existing good practice and stimulate discussion on further improvement and innovation. Successful strategies featured in the report involve positive partnerships between NHS trusts and higher education where the partners consult on procedures and develop joint initiatives together.
	The report highlights an active approach that balances the expansion of access with the recruitment of a high quality workforce. To give just four examples, Keele University has customised local access courses to prepare mature candidates who wish to enter nursing education. As my noble friend Lady Lockwood said, the University of Bradford is at the forefront in identifying barriers to the recruitment of local ethnic groups. The University of Northumbria also specialises in this area. The University of Central England has a postgraduate diploma in nursing which enables graduates in relevant disciplines to qualify as nurses in two years. Middlesex University's Centre for Nursing and Midwifery has arrangements for closer links with clinical practice.
	The recruitment drive, from which all this has sprung, is already showing results. There has been a significant rise in the number of student nurses. In England, the vast majority of commissions for nursing education--approximately 90 per cent--are at diploma level and the remainder are for degrees. The rise in the number of both those categories of students has been considerable.
	That reflects the key role of universities in attracting more students into the profession and working closely with partner NHS trusts at local level to achieve recruitment targets. Applications for nursing diploma courses rose by 18 per cent from 1998 to 1999 and for nursing degree courses the increase was even higher at 24 per cent. Although that may not address the existing problem, it augers well for the future.
	I turn to the third of my areas of progress: the demand for high-quality academic and practice-based education. The government report, Making a Difference, rightly acknowledged that a stronger practical orientation to nurse education is needed and that students should be adequately prepared and supported prior to and during their placements.
	Universities cannot achieve these objectives alone; they rely on the NHS to provide practice placements of suitable quality and length. I want to re-emphasise one of the problems raised by the noble Baroness, Lady McFarlane, about the present contracting arrangements between education consortia and HEIs. I refer to the fact that the responsibility for placements has been left largely to HEIs, so the growing recognition in the NHS that this is a shared responsibility is welcome. Every practitioner must share responsibility for the support and training of the next generation of nursing staff, as Making a Difference makes clear.
	Universities have systems in place for collaboration with service partners to manage and provide support for students on clinical placements, to achieve a better integration of theory and practice. Perhaps I may give two examples of innovative practice. The first is new educator roles to guide and support students through their clinical placements, as seen at the University of Bournemouth and the University of Central England. The second is clinical practice at Middlesex University Centre for Nursing and Midwifery, which has facilitated closer links with the NHS trust under the motto "moving forward in partnership".
	As others have said, nurse education has experienced major organisational changes during the past 10 years. It is now entirely within the higher education sector. As the noble Baroness, Lady McFarlane, said, the challenge for today's nurse educators is to prepare students to work effectively in a highly competitive, highly technical, extremely stressful and demanding environment.
	In order to face this workplace, nurses require a far greater level of knowledge and intellectual understanding than ever before. They may even need degrees. I say that because for some it is difficult to accept that nursing might require degree-level education. I find such an attitude not only regrettable, but also rather patronising.
	Finally, I turn to future developments. A sufficient supply of healthcare professionals who are educated to a high standard and are fit for the purpose is a vital aspect of the modernisation of the health service. The National Audit Office and the Audit Commission are undertaking a joint study on non-medical education and training in order to examine how the NHS addresses this challenge. We in higher education welcome this study because we believe that it will assist in the further development of our partnership with the NHS by offering an independent view on issues of organisation, funding and value for money.
	Higher education provides the infrastructure and climate to support the development of those analytical skills and the evidence-based practice required to underpin quality nursing care needed to meet the needs of patients now and in the future. And, as has already been said, quality patient care is the objective that the university/NHS partnership aims to satisfy.

Baroness Emerton: My Lords, I thank my noble friend Lady McFarlane for introducing this important debate. I endorse her remarks on the presence of the noble Lord, Lord Morris of Castle Morris; we are pleased to welcome him back to his seat.
	I declare an interest. I cannot claim to aspire to the title of matron but, like the noble Baroness, Lady Cox, I am proud to claim the title of nurse. I have 47 years' experience working in the NHS and currently I am chairman of an NHS trust. I have a background in nursing practice, teaching and management as well as the work of the self-regulatory bodies.
	As we debate this important issue of nursing education and practice, I should like to quote a definition of the unique function of the nurse which was written by the late Virginia Henderson in the 1950s. I have yet to receive a more recent definition which describes the functions so ably, but the quotation given by the noble Baroness, Lady Cox, certainly enhances what I am about to quote. It is:
	"The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible".
	The rapid changes in nursing practice in recent years have been due to the major developments in medical science and technology which have called for changes in nursing education programmes, both pre- and post- registration. However, developing and maintaining the art and science of nursing practice have to be based on the close correlation of theory to practice, whether it be in the delivery of fundamental aspects in nursing care required by patients or the care provided in critical care areas which demand advanced knowledge and skills.
	It is interesting to note that the Health Service Commissioner, in Chapter 2 of his report for 1998-99 published in August last year, made the comment:
	"What sort of nursing and midwifery complaints reach my office? I see many concerns about the traditional areas of nursing care, including prevention and treatment of pressure sores, hygiene and provision of food and fluids. Falls while in hospital and delay in receiving attention also feature regularly. In midwifery complaints, a frequent issue is the 'debriefing' of patients following labour: that is, giving a woman the opportunity to review her labour and birth and offering explanations to her of what happened".
	We all hear anecdotal reports of delivery of care, more often than not erring towards the negative rather than the positive, but the Health Service Commissioner's report includes well-researched evidence which gives him cause for concern, as he described, in the "traditional areas of care"; what perhaps I would describe as fundamental nursing care. I am reminded of the inescapable human desire for food, shelter, clothing, love and approval; the fundamental human needs. Whether a patient requires continuing care or is in an intensive care unit requiring critical care of a highly technological nature, he or she still requires basic human needs to be met in the delivery of nursing care. That requires high quality practice.
	For that to be achieved, we require high quality preparation through adequate and appropriate education programmes within a standards framework which produces competent practitioners able to provide the care needed, and therefore to deliver a high quality service, and those standards being subject to regular monitoring.
	Within the past few weeks there have been many references within the House to the shortage of nurses and midwives both following the Statement on the NHS on 10th January and during the debate on maternity services on 12th January. The Government are leading an enormous effort to increase the number of nurses, midwives and health visitors which has been helped by the Government's acceptance of the recommendations of the pay review body. In addition, an enormous programme of work is under way to bring about changes, including legislative changes, to meet the recommendations of the review of the Nurses, Midwives and Health Visitors Act; the Government's strategy Making a Difference; the UKCC report Fitness for Practice; the Health Act 1999; and the Government's recent announcement to create in England a new education and training unit.
	The modernisation of self-regulation as part of the Government's general programme of modernising the NHS is of great importance to the nursing, midwifery and health visiting professions. Effective self-regulation of the nursing profession is paramount to protecting the public who may become patients by virtue of having in place a standards framework for the education, practice and conduct of nurses. That regulatory framework ensures and enables nurses to practise confidently and competently at the point of registration. The users of health services can be reassured by the mechanisms that are in place that an individual has achieved the standards required to practise competently and can access mechanisms to verify that fact. In addition, it assures employers that registered nurses possess the knowledge and skills needed to provide the care that patients require.
	Professional self-regulation of the nursing, midwifery and health visiting professions has served patients well through the Central Midwives Board (1902), the General Nursing Council (1919) and, since 1983, through the UKCC. The Health Act 1999 will be the vehicle that brings about changes to the current regulatory framework. The Act will facilitate the repeal of the existing Nurses, Midwives and Health Visitors Act 1997 and secure the introduction of an order designed to create a new United Kingdom regulatory body.
	During the passage of the Health Bill assurances were given by the noble Baroness, Lady Hayman, to a continuing commitment to the maintenance of self-regulation and that adequate consultation would be undertaken at the drafting stage of the order. I hope that the Minister will be able to reaffirm those assurances.
	I also ask the Minister to confirm that the new UK-wide regulatory body will retain the power to set standards and to ensure that their achievement will be retained. That will be essential in ensuring that the future practising professional is competent and capable of working in any countries of the United Kingdom. As I understand it, regulation is a reserve power retained by Westminster. However, it is recognised that implementation issues emerging from creating a UK-wide regulatory body must be considered within the context of devolution. What must be avoided is a fragmented approach to the regulation of nursing, midwifery and health visiting professions resulting in a practitioner having to seek additional verification to practise when moving from England to Wales or Wales to Scotland or from Scotland to England.
	The Government's proposals to secure legislative changes by September 2001 present an ambitious timetable. My limited experience from being involved in the passage of the Nurses and Midwives Act 1979 and the 1992 Act remind me of the complexity of introducing legislative change which affects personally such a large number of people currently on the effective register and the future generations, as well as the professions corporately. There will be consequential organisational change and cultural change which will need expertise in the management of change.
	I believe that consultation on the proposed order is of paramount importance. I ask the Minister to ensure that not only is there adequate time given to the consultation period, but also that mechanisms are put in place to ensure that 300,000 registered practitioners in the NHS across the United Kingdom and those practising as registered nurse practitioners in the independent and voluntary sectors can be consulted. There remains a certain level of anxiety in the profession. Through the means of an affirmative order nurses need to be reassured that the Government will take account of the comments received in consultation as there will not be any debate in either House. It cannot be over-emphasised that regulation is of the greatest importance to the public and employers and of particular importance to registered practitioners. It is important that they understand and agree with the new arrangements which will assure them that they can practise confidently and competently at the point of registration.
	Finally, I make reference to the recent consultation document issued by the NHS Executive entitled Consultation on a Partners Council. That will support the Department of Health in strengthening and managing nursing, midwifery and health visiting education. The proposal is to extend the remit to promote multi-professional learning and working. The establishment of the new regulatory frameworks for the professions allied to medicine and the new regulatory framework for nursing, midwifery and health visiting, subject to legislation, together with the current passage of the Care Standards Bill promoting the national care standards commission, all point to the need for closer collaboration between the statutory bodies. The partners council would assist in working together in providing the "seamless service" so often referred to in the provision of healthcare.
	However, as well as at national level, I urge the Minister to encourage greater involvement within the NHS of chairmen and chief executives of NHS trusts, primary care groups, primary care trusts and health authorities in the cultural changes necessary to bring about the changes in nursing and midwifery and health visiting education through closer involvement with the universities, as well as ensuring that within the framework of clinical governance programmes for their organisation account is taken of the requirement for lifelong learning to take place within the framework of self-regulation, which in turn will ensure that a high quality of care is delivered to patients in the primary care sector and in the hospitals.

Lord Harrison: My Lords, I congratulate the noble Baroness, Lady McFarlane of Llandaff, on bringing forward this debate today. Like her, I welcome what this Government have done for health in general in the form of additional resources of £21 billion; for nurses in particular who were awarded a generous, above-inflation pay increase, and the recruitment over three years of 15,000 new nurses along with 1,000 doctors and a scheme to encourage 3,000 to 4,000 returnees to the profession. The document launched last July by the Prime Minister entitled Making a Difference is already making a difference by strengthening the nursing, midwifery and health visiting contribution to health and healthcare provision in Britain today.
	I also celebrate the Government's readiness to think boldly about the aims and objectives of a modern health service. In particular I welcome the conviction of the Secretary of State, the right honourable Alan Milburn, that a modern NHS must increasingly respond to the patient in the form of consumer needs. It is bold because against a tide of rising expectations it would have been easier to take the route of capping such vaulting ambition.
	I also rise to speak as a recent consumer of the NHS and of the care of the nursing profession found in community, GP and hospital nursing. I declare immediately my unshakeable faith in, and admiration for, the nursing profession. As with any job, the acid test is whether I would be prepared to do it myself. The answer is decidedly not. Our nurses daily face duties that we mere mortals would run a mile to avoid.
	Having said that, my experience in hospital was of some chaos. No amount of tender loving care could quite repair the impression of disorganisation of the nursing care that I received in hospital. The unacceptably high turnover of staff led to contradictory practice and to my annoyance at being repeatedly asked "What is wrong with you?" In my case there also appeared to be a lack of understanding about the care of diabetics injecting insulin. The combination of a diabetic diet with the ubiquitous chips and sugary sweet puddings was nothing short of stomach-turning.
	I learnt much else during my period of convalescence regarding the education and training of our nurses. First, there is concern that there is too strong an academic bias at the expense of hands-on experience in current training practice. Giving greater responsibilities to student nurses, even for specific patients, builds confidence as well as competence. The early opportunity for students to effect basic injections or dressings on medical and surgical wards is not encouraged as much as it might be. The emphasis remains on observing more than serving. As one senior nurse put it to me, such students become proficient at bed-making and not much else. That in turn becomes a lose-lose-lose situation, where the student is frustrated, the staff nurse overworked and the patient confused.
	Of course, the academic and practical should go hand in hand. The justification for supernurses may be that technology is moving so fast that we urgently need skilled nurses who can absorb and use modern technology to the patient's benefit. But it is true also that many medical technological advances have made therapy easier, not more difficult, and are, therefore, available to a wider range of nursing staff. We should not mystify the mystique of medicine. Indeed, I am informed that some hospital trusts are shy of the highly-trained nurse whose avocation is directed towards the high dependency unit or the theatre but who lacks basic, practical hospital skills or the inclination to exercise them. Surely the trick in all this is the necessity of matching various levels of nursing skill against the needs of a modern health service--indeed, against the needs of the consumer. Diversity is key. In this regard, I am particularly pleased that the Government have set in motion a more flexible approach to nurse education and training.
	However, let me redress the balance slightly by reporting on my experience of a nurse at the Countess of Chester Hospital, undertaking original research in leg ulcers while holding down a day job in the clinic. It was impressive to see the team spirit adopted by all those concerned in supporting her ground-breaking research, including the unstuffy consultant surgeon who willingly helped the nurse with her information technology needs. We should be proud of the developments that break down authoritarian, hierarchy-ridden prejudice, which stands in the way of creating new models of nursing and co-operative healthcare.
	Let me animadvert to some other concerns. Trivial as it may seem, the delay in forwarding bursaries from the Blackpool-based grant authority, sometimes representing eight to 10 weeks' money to student nurses, is having a discouraging effect, especially on those from less-favoured backgrounds where training for nursing may mark a huge personal and financial commitment. I know that students who attend the excellent School of Nursing at University College, Chester have suffered in this way.
	I should also like to bring to the attention of the Minister the enormous differential, perhaps of the order of 400 per cent, in the cost of training nurses in different parts of the country. In the north-west the average figure is £4,000; in London and the south-east £15,000 is nearer the mark. Not all of that discrepancy is explicable in terms of cost of living, research obligations or the incorporation of building costs in the comparative statistics. Will the Minister comment on that, and on the desirability of publishing comparative training cost figures?
	Will the Minister also speculate on another aspect of the north/south divide? I am given to understand that the recruitment of locally-based, quality student nurses is buoyant in the north. In London and the south-east, recruitment is patchy. What is the Government's strategy in this regard?
	I turn to my final comment relating to Britain and the European Union, where the Maastricht Treaty conferred an obligation on member states to share best practice in the field of public health. Should not such co-operation also be extended to sharing best practice in nurse training and practice? During my period of recuperation while still an MEP in Brussels and Strasbourg, I was surprised at the variety of nursing practices exhibited by the French, Belgian, German, Finnish and Italian nurses who looked after me so well. My strong recommendation is to always be ill in English
	With the advent of the internal market--Europe's single market, not that of the health service--promoting the free movement of people and, therefore, the free movement of patients and nurses, should we not do more to encourage the sharing of best nursing practice, education and training, aiming for the higher standards of healthcare throughout Europe? For example, I understand that in the EU, as well as in the States, nurses habitually undertake tasks which we still restrict to junior doctors.
	I remind your Lordships that the 48-hour working week for junior doctors emanates from Brussels and is to be thoroughly welcomed. The thousand new doctors and the conferring of flexibility on our nurses to perform additional and more complex tasks will be needed to make up the shortfall in staff hours resulting from the Government's ambition to eliminate the shame of the overworked junior doctors, who are sometimes too tired to think on their feet.
	The Government's welcome and stated goal of matching European Union average funding in the health service also points to the future where there is much to be gained in liaising with our European Union friends and partners, and nowhere more so than in the area of nurse training, education and practice.

Viscount Bridgeman: My Lords, I should like to add my thanks to the noble Baroness, Lady McFarlane, for initiating this debate and say what a particular pleasure it is to see the noble Lord, Lord Morris of Castle Morris, in his place again.
	There is an increasing difficulty in the matter of nurse training in the interface between the private and voluntary sector and the National Health Service. Of course, the NHS is where virtually all pre-qualification and training take place. It is difficult to see how that will be changed substantially since the NHS is where the full range of types of nursing currently exists. In the past, many independent sector providers have been content to live with that position. After all, training is expensive.
	However, the position is changing. Independent providers are becoming involved increasingly in post-registration training and return to nursing. There are now substantial areas of nursing--care of the elderly, mental health and learning difficulties, to name only three--where the independent sector is a significant majority provider. Indeed, in the case of care of the elderly it may soon be difficult for nurses to gain experience outside the independent sector. Nurse training must recognise the fact that 25 per cent of nurses now work in the independent sector. Training must address the needs of independent providers in terms of strategic workforce planning and specialties. I should like to see educational experience routinely involve independent providers, and that should, of course, become a two-way initiative.
	I have the honour to be chairman of an independent charity hospital which embraces both a private acute hospital and a hospice. In the latter, we have contracts with several local health authorities and are uniquely well placed to see the interplay between the two sectors. It is gratifying that mutual dependence and awareness of mutual benefits is becoming progressively greater. Never again should there be occasion for the rather sardonic remark made to me--quite apart, I may say, from my own hospital--that the Department of Health must not be a department of the NHS; it must be a department for health for the whole nation.
	I refer to two other small matters. One is the problem of the registry of healthcare assistants. Historically, there has been resistance to include non-professionals in the UKCC. As matters stand, the Care Standards Bill provides for the general social care council to embrace only care workers performing personal or social care functions and would appear to exclude healthcare assistants. Many healthcare assistants will routinely do a number of both health and social work jobs. The cross-over is particularly acute in nursing homes, homes for those with profound learning difficulties and mental homes, all of which, as it happens, are predominantly in the independent sector.
	I understand from my noble friend Lord Howe that in the course of the Committee stage of the Care Standards Bill the Minister said that he was aware of that problem. We should like healthcare assistants to have the option of being able to register with either the UKCC or the general social care council. At the very least, registration with one body or another would inhibit the practice of healthcare assistants being rejected as unsuitable in one part of the country and being able to apply for a job, unmonitored, in another.
	My final point reinforces a matter raised by the noble Baroness, Lady Emerton. Health and social care are devolved matters. There is a danger, particularly in the early stages of the new parliaments and assemblies, that occupational standards, educational syllabuses and so on will be drawn up independently of the other jurisdictions. That would be hugely inefficient, costly and counter-productive and may lead to the reinvention of the healthcare wheel. I hope that the Minister has that problem high on his list of priorities and is in touch with his opposite numbers in the devolved bodies.

Lord Morris of Castle Morris: My Lords, I should like to make just five simple points about this subject. The quickest way for me to make my first point would be for me to undo my coat, lower my trousers, lift up my shirt and show your Lordships my tummy.

Noble Lords: Order!

Lord Morris of Castle Morris: I shall not do that. It is a mass of painless blue bruises caused by two months of daily injections of Tinzaparin. It is an anti-coagulant which almost always bruises because anti-coagulants do. It has to be administered subcutaneously by a trained and skilful nurse unless you want the patient to look like an ancient Briton, ready for battle and covered in woad.
	The point is that not all even subcutaneous injections are as simple as they seem. Nurse education requires knowledge plus a high level of manual skills constantly practised. I was delighted to see that recognised by recommendations 10, 14, 16 and 20 of the Peach report, Fitness for Practice, for the UKCC.
	We have all heard of consultants and registrars grumbling that newly qualified nurses arrive on the wards full of theory but it takes six months before they are perfectly competent in practical matters. Thanks to the Peach commission that should be heard less often in future. But students must be instructed and must be able to practise the acquired skills before they are let loose on hospital wards.
	My second point concerns access to nurse education. The cadet scheme, aimed at 16 year-old school-leavers, is a popular success with the trusts. Experience at Sandwell, Rochdale, Lincoln and Warrington has been encouraging so far. A cadet who achieves a level 3 NVQ at Sandwell, for example, is guaranteed a place on a nurse education course at Wolverhampton University and is guaranteed a job with the trust when the course is completed successfully. That is an excellent idea. That is what will bring people in.
	Similarly, the Government are to be congratulated on pledging financial support for healthcare assistants to become registered nurses. That fast-track recruitment is a safe and sensible system but it needs careful organisation. In particular, trusts must be sure that universities can provide places for such students and can meet their special needs. Mature HCAs often have families to take into account and financial arrangements which are very different from those of--shall we say?--an 18 year-old school-leaver coming up to university to read English literature. Therefore, universities must be far more flexible in matters like transfer from one university to another if we are not to lose students we desperately need.
	Incidentally, a great deal of misunderstanding exists about the drop-out rates in nurse education. We have been talking across the Benches here and figures of 30 per cent, 24 per cent and 18 per cent are often quoted. The point is that the figures for nurse education are based on the number not taking up their bursaries for whatever reason. A student nurse taking maternity leave counts as a drop-out, as do the long-term sick, whether it is meningitis or a broken leg that causes the temporary absence. A student who chooses to take a break is a drop-out. That is not true for comparable university departments and it gives a very false picture of nursing students. Will the Minister please help to remove that depressing anomaly as swiftly as possible?
	My third point refers to the weakest in the whole system--clinical placements, which everybody agrees needs a lot of attention. Nursing is still rooted in practical caring skills and those can be achieved only by hands-on experience. But good placements, like good women, are hard to find. The NHS system is estimated to be 17,000 nurses short. I have never quite been able to find out how that number is calculated but nobody seems to disagree with it. So those who are working are having less and less time to instruct learners. The old industrial system of, "Go over there and sit next to Nelly and you do what she does and you'll soon learn", will not work in a busy hospital where nurse Nelly is rushed off her feet and simply does not have the time. I have small faith in the idea that a student can learn much by silent observation.
	I suppose that every university department with a nurse education course has its version of the story which I first heard in a South Wales hospital where a student "observer" accompanied a ward sister and others handing over from one shift to another. In the midst of that, a patient in bed groaned and turned distinctly green. "Go and see what's the matter, will you, please?" said the sister to the student. "No", said the student, "I am here to observe, not to do things". "Right", said the sister grimly, "well, you just observe Mrs Jones because she has just vomited all over the bed and we'll observe you cleaning it all up, isn't it?"
	There just are not enough trained and qualified nurses on the wards to guarantee that form of sophisticated apprenticeship and it is too expensive to do badly. In any case, there are not enough placements to go round. The situation in hospitals is static because bed numbers have been frozen and nurse numbers are at a premium. But student numbers are extremely buoyant. You cannot get a quart into a pint pot.
	University nursing departments are having to seek placements for students in hospices, GP practices and mental health units, which are not often places of relevance because they are so specialised. I respectfully ask my noble friend to cause a long and serious inquiry to be undertaken into the problem of placements. It can be even more acute in post-registration education, as Carol Midgley wrote in The Times of 20th January about the problems of any kind of instruction in an ICU or even in an accident and emergency department.
	My fourth point is that it was the first century Latin satirist Juvenal, was it not, who wrote "Quis custodiet ipsos custodes?"--"Who is to guard the guards themselves?" Who, where and how qualified are the teachers who will teach that theory part of pre-registration education, the classroom component? I am told that a nurse teacher would require a 3-year diploma, then further part-time work to achieve degree level. This would be followed by a part-time Masters degree taken while working and she would be en route to a doctorate completed, again, part-time before she would be teaching.
	That may attract the equivalent of a ward sister's salary within about five years of registration and a settled career thereafter. That may be desirable but it would not be compulsory to have any teaching qualification whatever. That can hardly be satisfactory in a university situation. Can my noble friend assure us that all those who now teach nursing students in universities are tested and qualified and fit to do so? The RCN in its briefing for this debate says:
	"The RCN is looking carefully at this issue and is working on a new model for preparation of those who teach nurses".
	Can my noble friend describe the old model and tell us what is wrong with it?
	Fifthly, and finally, I am concerned about the status of the new departments which are now up and running in 89 universities in the United Kingdom. Are they an accepted and an integrated part of what we may call the British university system? I am fearful for all this because recently there has been the serious suggestion that nursing students should be returned to employee status. The RCN and many others are seriously worried by and opposed to that. I am puzzled that any nursing student should prefer to be an employee with a salary to being a student with a bursary. In my view, it is far more important that they should be given access to student loans and that a fair proportion of Blunkett's bounty of £68 million, announced yesterday, should come their way, as I hope my noble friend will assure me.
	I want nursing students to have exactly the same status as all other university students. The dean of nursing at Sheffield shrewdly announced to the university that she would not consider her students fully integrated until they had every Wednesday afternoon free to allow them to play Rugby football. She has a point!

Baroness Masham of Ilton: My Lords, I am pleased to follow the noble Lord, Lord Morris of Castle Morris. I congratulate him on his excellent speech. I am delighted to see him back in your Lordships' House.
	With great pleasure I thank my noble friend Lady McFarlane of Llandaff for instigating this debate. We desperately need well trained nurses who do a good job and have job satisfaction, whether in hospitals or in the community. I know that the Minister will not agree with me--although many people do--when I say that doing away with the state enrolled nurse, who trained for two years, was a retrograde step. The state registered nurse and the state enrolled nurse complemented each other.
	Often the state enrolled nurse became part of a ward, working there for a long time, or she worked at night when her partner was at home. Now nurse assistants have taken her place. They have little training and are dressed in uniforms so that many patients do not realise that they are looked after by an unqualified person. With high-tech nursing there is a need for highly qualified nurses, but there is also a place for reliable, practical nurses.
	Last year, at a reception in the other place, I met a well-respected and well-loved elderly actress. She had just come out of hospital, having had her foot operated on after a fall. As I had met her several times before, I asked her how she was getting on. She told me that one night in hospital a lady in the next-door bed needed a bedpan but could not ring her bell. The actress rang her own bell to call the nurse. When the nurse arrived she was furious, swore at them and told them off. That happened in one of London's teaching hospitals.
	What are we teaching the modern-day nurse? Have our standards fallen so low? We appear to have a multitude of agency nurses who are not supervised. Night superintendents used to visit the wards to check on patients and nurses. At night patients are often at risk from uncaring nurses. Often during the day the ward sisters are not on the wards instructing young doctors and nurses but are busy in offices burdened down with administration or attending meetings. Nurses coming from college still have a great deal to learn as they put theory into practice.
	When I was in a serious condition in hospital I found that the nurses who were on a special post graduate course in spinal injuries were by far the best. They were interested in what they were doing and keen to learn. Is it not true that an expert is someone who continues to learn?
	I am president of the Spinal Injuries Association, which works closely with the various professional bodies looking after the care of its members. At the moment the most important body happens to be the Royal College of Nursing. Last year at our AGM several members raised the point that when they had been admitted to a district general hospital, usually as an emergency, they had been refused a manual evacuation of their bowels. Many people with spinal cord lesions utilise manual evacuation as their established and routine method of bowel management at home. Therefore, they cannot understand why it is so difficult to continue to receive appropriate bowel management after admission to a district general hospital.
	That refusal by nurses has caused some of our members great distress and has put them in danger. The actions and activities of all UK registered nurses are guided by the code of professional conduct published and policed by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting. The primary requirement of all nurses is to,
	"act always in such a manner as to promote and safeguard the interests and well-being of patients and clients".
	A nurse is expected,
	"to acknowledge any limitations in her knowledge and competence and decline any duties or responsibilities unless able to perform them in a safe and skilled manner".
	If a nurse cannot undertake a manual evacuation, she should identify an appropriate source of assistance in order to maintain her patient's established programme of care. She is required to represent her patient's needs and her inability to meet them to her ward manager or senior nurse. Unfortunately, the recent experiences of some Spinal Injuries Association members suggests that some nurse managers are unsure of how to deal with the situation properly. Many are of the mistaken impression that nurses are forbidden to undertake manual evacuation. The Royal College of Nursing is helping to sort out that kind of situation. This is an example of how voluntary organisations, which often know the needs of their members, can be of benefit to individuals when they work closely with professional bodies such as the RCN.
	There are many different disabilities and when people become ill many problems arise. Therefore, I am pleased to say that on 2nd March the Royal College of Nursing is holding a conference on disability awareness and nursing.
	Section 21 of the Disability Discrimination Act 1995 places new requirements on health service providers. It is vitally important that all nurses are educated about disability in order to influence service provision so that disabled people receive the service that they want rather than the service that they are given.
	Two weeks ago the TV programme "Panorama" showed that paramedics who have to deal with critically ill patients at the roadside, in the home and in the community at large have only six weeks' training. That led to a great many worried and surprised people. What reassurance can the Minister give in that regard?
	In conclusion, many clinical nurse posts specialising in HIV are under threat as the cost of providing anti-retroviral drugs is increasing. Basic pre-registration and specialist post-registration training needs to ensure that all nurses have a good basic understanding of medical issues in relation to HIV, including the cultural issues of the communities affected, particularly gay men and African people living in the UK, and the maternity needs to protect the child of an HIV-infected mother.
	The training also needs to stay up to date with medical advances. Historically, nurses were trained to see HIV as a terminal condition. Now they will be seeing a much greater number of people with HIV exhibiting a wider range of symptoms. The Royal College of Nursing should be congratulated on producing a sexual health strategy. Sexual issues may be behind a whole range of mental and physical problems. Nurses need to be made aware of those. We seem to live in an increasingly complex society. Without a healthy nation we will face growing problems. Every nurse should learn the importance of health promotion.

Lord MacKenzie of Culkein: My Lords, we must be grateful to the noble Baroness, Lady McFarlane of Llandaff, for initiating this debate this afternoon on such an important subject. Also, I too am pleased to see my noble friend Lord Morris of Castle Morris in his place.
	Last year, over several months, the journal, Nursing Times, ran a feature entitled "Nurse heroes of the century", to which I was invited to contribute. I rather indulged myself because I picked two heroes. One was that brave French army nurse who became famous as the "Angel of Dien Bien Phu", Leiutenant Genevieve de Galard. My other hero was someone rather different--an unqualified but brilliant nurse teacher who made it a pleasure for all young student nurses who were eager to learn to return to the class.
	So I place great value on nurse education, whether it be degree or diploma courses or in the clinical environment. I have also always supported the need for a level of nurse education to be based in the higher education sector. Indeed, with nurses pushing out towards the frontiers of medicine, how else can it be?
	I spent many a long day and evening justifying and supporting what became known as Project 2000. But I also supported the need for a new type of practitioner in addition to the first-level nurse; a new, second-level nurse to be quite different from the enrolled nurse as we knew it. With a number of senior nurses I campaigned strongly for that new type of nurse, since we believed that all levels of practitioners, however designated, should have access to education to a required standard and should be regulated by the statutory body, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting. That battle was lost, with the consequences which ensued. I shall not repeat them this afternoon; they are set out at col. 42 of Hansard of 13th December 1999.
	As a result we had healthcare assistants and the appalling mistreatment of enrolled nurses. That was coupled with equally bad workforce planning by the then government. Health departments of the time and the pay review body ignored the warnings of the staff organisations as then articulated by my very good colleague, the late Trevor Clay of the Royal College of Nursing and myself from the Confederation of Health Service Employees representing the nurses of this country. The nursing shortage was as predictable as night follows day.
	So it was with some considerable relief that I read Making a Difference where the Government set out their strategic commitment to enhance the role of nurses and--dare I say it?--to enhance the role of nursing. It is clear that the recommendations by the pay review body and the speedy acceptance by the Government had a positive effect on recruitment into nursing. It is reported that there is a 24 per cent increase in degree students and an 18 per cent rise in those taking up diploma courses. That increase is indeed a welcome start to redressing the many years of neglect. But more needs to be done: more in terms of pay and conditions; more in relation to family-friendly policies; and more too in relation to other measures to keep nursing students for the three or four years of their education and clinical placements.
	As we heard this afternoon, nursing must compete with the plethora of opportunities offered up in higher education and in later life, often with more attractive salaries and career opportunities. Added to that, nurse students are different from the vast majority of their cohorts. As I understand it, their academic year is 11 months. In clinical placements there is a 37½-hour week commitment. We know that too many nursing students are working as healthcare assistants or in other jobs to make ends meet. So, far from having Wednesday afternoons off to play rugby, they have a great deal of hard work in front of them and a long academic year. It is not quite the higher education experience enjoyed by most other students in higher education and that may contribute to the drop-out rate about which many of us are unhappy.
	Despite what has been said this afternoon, given that there are those differences in relation to other students, consideration must be given to reviewing whether bursaries, grants, loans or some form of training allowance should be reintroduced. I note that in this year's pay review body report to the Government it is still recommending student and pupil nurse training allowances. So far as I know, there are no conventional, old-fashioned, apprentice-based nurse training courses left in the United Kingdom, though the review body still recommends payment up to £10,155 for a third-year student. Something on those lines may well contribute towards keeping our students at university to complete their courses.
	One of the disappointments with Project 2000 is the fact that some newly-qualified nurses are not equipped by the education system with the necessary skills required to provide what the Department of Health describes as "effective" practice. I go further and question whether "effective" in some cases should be substituted by the word "safe".
	It is necessary that there be a strengthening of clinical placements, supervision and mentoring. I know that steps are being taken towards that. Again, as we heard this afternoon, the pressures on staff in the healthcare sector today are such that it must be enormously difficult to continue to inculcate the ethos referred to in Making a Difference; that is, that all nurses share the responsibility to support and teach the next generation of nurses. That ethos is not new. It existed when I started nursing more than 40 years ago but it deserves restatement.
	Wards today are far too often staffed by healthcare assistants, the residual nursing auxiliaries and many qualified staff from agencies. It is not surprising therefore that monitoring is difficult--so much so that I suspect it may not be too long before someone tries to produce a computer-generated model of a virtual ward, no doubt with virtual patients. Like the noble Baroness, Lady McFarlane of Llandaff, I have no wish to go back to project-based training, but I have little doubt that both she and I experimented with our first injections on an orange, and I think that is much better than on a virtual orange!
	Entering into nurse education will be facilitated by that most welcome move, the reintroduction of nursing cadet schemes: indeed events turn full circle. I also think that the initiative that has become known as the stepping on and stepping off is excellent. This will enable a student to leave a degree programme after, say, 15 months with sufficient qualifications to practise as a senior healthcare assistant and will enable young people to take a break for whatever reason--whether the cause is falling pregnant or caring for an elderly parent--and not be lost to nursing or to the health service. I hope that they will return to university to take up and complete their degree course, and so stepping on and stepping off is right and sensible. Can my noble friend the Minister say whether it is true that some higher education establishments are unhappy about this concept and indeed may be lobbying against it? I am not quite sure why they might do that: it might be the notion of "bottoms on seats" and money following, or perhaps they do not particularly like the flexibility of this approach, but I should like to be reassured that this rumour which has reached me is not true.
	I want to return for a few moments to care assistants. A recent survey shows that almost one-third of NHS trusts do not give non-registered nursing staff, whether healthcare assistants or nursing assistants, access to national vocational qualifications. The grade of healthcare assistant was introduced some years ago on the back of the theory that there would be access to national vocational qualifications with a "links and ladders" approach to pay and promotion or grade.
	Much of this has not happened. Whatever good intentions existed were swept away by the other driver to the introduction of healthcare assistants, which is cost-saving.
	Healthcare assistants are outside the remit of the pay review body. They are generally paid less than nursing assistants. There is evidence that perhaps the majority who do gain national vocational qualifications do not get better pay or any promotion. I therefore hope that my noble friend will indicate whether it is possible to require, or at least lean fairly heavily on, health trusts to give all healthcare assistants at least access to NVQs and to use the "links and ladders" approach to pay and grading. I am strongly of the view that while good works have been done in increasing the pay of newly-qualified nurses and of experienced staff nurses, we also need to attend to the underpinning: the healthcare assistant, the auxiliary and the enrolled nurse. It would do much for morale, confidence and workforce planning, and not least for a greater resource for fast-track entry into higher education, if more care were given to that end of the nursing workforce.
	Healthcare assistants are often mature adults. They are a known quantity to the employer; they are of the community in which they live and work and, when qualified as nurses, they will no doubt return to serve that community. Like the noble Viscount, Lord Bridgeman, I too am concerned that healthcare assistants should be brought within the remit of the United Kingdom central council. I said earlier that I am strongly of that view.
	I will leave the matter there. Much good has been done in the past two years for nurses and for nursing. Much more needs to be done, but there is light at the end of the tunnel. That is good for nursing, and what is good for nursing is good for the patient and the client.

Lord Clement-Jones: My Lords, it has been a great pleasure to listen to this debate. I declare an interest in that my two sisters were trained as nurses. One of them works as a health visitor and the other as a theatre sister. I have found it extremely valuable and illuminating listening to the debate and to those who have expressed both their professional and personal experience. I am only sorry that the noble Lord, Lord Morris of Castle Morris, cruelly denied us a practical demonstration half-way through the debate!
	I think it is true to say--and certainly this is very much the tenor of what noble Lords have had to say--that the nursing contribution will be a crucial factor in determining the success or failure of the United Kingdom's health services in the 21st century. There are huge problems to grapple with, as has been made clear throughout the debate. We have heard that an additional 17,000 nurses are required, as the noble Baroness, Lady McFarlane of Llandaff, reminded us at the beginning of the debate. Some 140,000 nurses have left the profession in the last three years. Clearly we must recognise that recent recruitment initiatives may have had some success but we are faced with an ageing profession. Almost 25 per cent of qualified nurses are over 50, which means that we have a major issue of retirement looming.
	As regards district nurses the issue is even greater. In a survey last March it was found that the average age is 45, and most district nurses want to retire at the age of 55; so the issue of retirement is even greater. Set against these shortages, however, the noble Lord, Lord MacKenzie, was quite right to remind us about the use of nurse agencies, which has escalated greatly over the past few years. As a number of your Lordships have recognised, this is a false economy. I wonder whether the Government really are tackling that issue with enough vigour. This process has escalated heavily over the past few years. Some hospital trusts, such as the Royal London and Bart's, have something like 25 per cent of their nursing establishment vacant.
	If we are to attract nurses clearly we must create the right climate, as the noble Baroness, Lady Lockwood, reminded us. Indeed the Government's own document Making a Difference said that nurses need a more satisfying and rewarding career. One therefore needs to have the right climate and to set the training and education we have discussed tonight against the backdrop of certain key elements.
	The first of these is pay. It is clear that a one-off rise for nurses at any particular time is not sufficient. We need a commitment from the Government to consistent rises over a period. We saw the lower grades receive a higher pay average rise last year and we saw the higher grades receive a higher award this year. There must be consistency and there must be that commitment over a period of years. The pay of the newly qualified nurse is still low compared to other professions. The grade D nurse on registration receives between £14,890 and £16,445. There are still problems as between grades E and F. There is little differential between the grades, which gives little incentive to take on further responsibility by moving up the ladder.
	Turning to family-friendly employment policies, there was a Changing Times survey in 1998 which showed that 58 per cent of nurses have caring responsibilities for dependent children and/or dependent adults. Of those responding to the poll, 85 per cent said that family-friendly policies would encourage them to stay in nursing. Above all, they said more flexibility was needed. Quite clearly, the message has not got through to some trusts. What has been the response of the Government to the Melksham Hospital case: the Hale and Clunie judgment? Is the NHSE making sure that this does not happen again? Have health trusts absorbed the lessons of the way in which internal rotation systems were introduced and of their impact on married women?
	Thirdly, there is another major issue that we must look at in the context of nurse recruitment and retention plus training and education. Central to those aspects is the whole question of crime and health and safety in hospitals. Major causes of stress were identified in a survey of March 1998. Many of these incidents were workload-related; but the element of crime in hospitals is quite frankly unacceptable. A later survey showed that 50 per cent of all nurses said that they had been physically assaulted within the previous year. We know that the Government have been taking certain initiatives to try to prevent crime and to have better security systems in hospitals, but what has been the impact of government campaigns in this respect? What concrete results can the Government show?
	I move on to the question of education and training. A number of noble Lords have a vast amount of knowledge and experience in this area, but I think that the noble Baroness, Lady Masham, got it right when she emphasised the need for practical skills. Indeed, the noble Baroness, Lady Emerton, put it very well when she said that the absolutely fundamental issue was the protection of the public.
	In that context, like the noble Lord, Lord, MacKenzie, I very much welcomed the Peach Report, Fitness for Practice, and the Government's strategy paper, Making a Difference. There were concerns--and one cannot hide this fact--about the practical skills of the new intake. I thought that the phrase "academic drift" from the noble Baroness, Lady McFarlane, was very telling. One needs to review the status of training and assess how it is fitting in with the modern requirements for nurses. Sir Leonard did acknowledge a lack of practical skills and a "lack of confidence", which I thought was an interesting comment--indeed, the noble Lord, Lord Harrison, also referred to that--on the part of those going on practice placements.
	There were also the other steps suggested by Peach, such as the three-month practical placement before qualification and longer practice placements, the emphasis on mentoring and, as the noble Baroness, Lady Cox, pointed out, the emphasis on outcome and a competency-based approach. It was suggested that recruitment should be appropriate and that that should be the joint responsibility of colleges and hospitals. Finally, the actual return to a 50-50 split between practical and academic training was suggested as clearly being of great value.
	It is vital that we get the education and training of our nurses right. As I understand it, it costs something like £35,000 to train each nurse. We need to look at the nature of that education and training to ensure that that resource is being properly used. Indeed, is the drop-out rate 30 per cent? Is the noble Lord, Lord Morris of Castle Morris, correct in casting doubt on those figures? Whatever the figure may be it will clearly be high, so there is a major waste of resource. But why is there such a waste? We need to know the answer.
	We also need to know over what period of time the suggested reform will be implemented. I understand from the Committee of Vice-Chancellors and Principals that the new courses will be starting on 16 sites in September. Is that an adequate rate of progress? Should we be stepping it up? Does it mean that we have a sheep and goats situation, if you like, with a set of nurses being registered who do not have the practical skills that those trained in the new sites will have? It is important for us to ensure that we have that consistency as soon as possible.
	Many speakers referred to the way in which one can gain education and training in terms of the flexible routes towards achieving that end. I certainly welcomed the references to the stepping-on and stepping-off approach by the noble Lord, Lord MacKenzie, and to the access programmes mentioned by the noble Baroness, Lady Lockwood. We welcome those schemes to attract ethnic minorities to consider nursing careers, as mentioned by the noble Baronesses, Lady Lockwood and Lady Warwick. I could go on to talk about consultant nurses and the whole management process, which many speakers mentioned. However, time is short. What is quite clear is that generally there will be a much greater role for nurses to play in the future. I felt that the Crown report on prescribing was disappointing in some respects in that a clearer prescribing role was not outlined for nurses. Specialisms are becoming increasingly important. The role of nurses within NHS Direct and telephone helplines generally is of great importance. Clearly their role within primary care trusts and groups must increase as time goes on.
	Many speakers referred to healthcare assistants. That is a crucial issue. Our nurses possess precious skills and we must recognise that healthcare assistants will take over some of the non-clinical tasks. However, if they do so they must be properly regulated. Therefore, the Government's current consultations are of crucial importance.
	I am always willing to take inspiration from the Government Benches. The noble Lord, Lord Winston, for whom I have the greatest respect, said the following in 1998:
	"Successive governments have failed dismally to grant this profession of highly skilled and dedicated people the recognition and rewards they deserve ... If we lose our respect for the value of nurses then our society and its values are significantly cheapened".
	We all expect the Government to take the necessary steps to rise to this challenge. For me, that includes rewarding nurses properly and ensuring that they have the right resources, the right training and standards and the right working environment in which to exercise their skills. I look forward to hearing the Minister's reply to the debate.

Earl Howe: My Lords, this has been an extremely informative and constructive debate. Perhaps I may begin by thanking the noble Baroness, Lady McFarlane, for making it possible. If only to trump the noble Lord, Lord Clement-Jones, I am delighted to say that I, too, have a sister who trained as a nurse at the Middlesex Hospital and who went on to have a fulfilling and varied career, latterly in the specialist field of pain control.
	I do not think that one can approach today's debate about nurse training and practice without first recognising the backdrop against which it is set. In recent months nursing shortages in many parts of the NHS have reached crisis levels. The number of newly qualified nurses joining the UKCC register has dropped by nearly 18 per cent in four years and, as a number of noble Lords reminded us, according to the most recent RCN figures nurse vacancies are running at around 17,000 compared with 15,000 nine months ago and 13,000 the year before.
	The Motion that we are considering is not directly about the issue of nurse recruitment and retention; but it bears importantly upon it, in that unless the education and training of nurses is got right--that is to say, unless it is sufficiently attractive and rewarding to a large enough number of aspiring nurses each year, and continues to remain so--the problem of numbers will get worse, not better.
	One of the key questions posed by commentators is this. Does nurse education, structured as it now is, serve to exacerbate or to ameliorate the current nursing shortages? To answer that it is worth reminding ourselves why Project 2000 commended itself to the previous government so strongly in the first place. In the mid-1980s, the NHS was experiencing a very high drop-out rate from nurse training. Demographic trends meant that nursing had to compete much more vigorously for new recruits from a diminishing pool of school-leavers. Greater intensity of care in hospitals and more sophisticated treatments, as well as the shift to a primary care-led service, all pointed to the need to educate nurses to higher levels and to integrate theory and practice in a more structured way than before.
	One of the handicaps that the nursing profession had to live with for years was that it was seen as a menial or low-grade occupation. To some extent, I am sorry to say, that is still true. It was essential to try to banish that perception: first, in order to maintain recruitment at adequate levels; and, secondly, to ensure that the NHS could draw upon the skills that it now needed from the nursing workforce--skills which were becoming increasingly complex and varied.
	That rationale for Project 2000 remains as valid today as it was at the outset. If anything, the justification for keeping the responsibility for nurse training with the universities is stronger now than ever before. It is difficult, for example, to argue, in the face of a rising number of applications for nurse training places, that the academic element of the programme is off-putting to potential recruits, though there is a good case, I think, for abbreviating and revising the common foundation programme.
	It is equally difficult to argue, as some do, that higher education has made nurses too clever for their patients' good, when all the time the clinical and organisational skills that nurses need in the surgery or on the ward are becoming more sophisticated. Nurses need to be "doers"; but, as someone said, they need to be knowledgeable doers. If we look ahead to the advent of genetics in diagnosing and treating illness, we can see that it would be unthinkable to exclude nurses from gaining at least a basic appreciation of the subject. On a less rarefied level, we need only think of the demands placed on nurses by the advent of clinical governance, NHS Direct and evidence-based practice to see that nurse education must be pitched at the appropriate level to make these and future developments work as they should. It is worth noting that nurse education in many countries around the world is becoming increasingly degree based.
	The noble Baroness and many noble Lords referred to the UKCC report, Fitness for Practice, which was published last September. I agree with the noble Lord, Lord Morris of Castle Morris--whose presence here I warmly welcome--that that report made an exceptionally valuable contribution to the debate about the future direction of nurse education. It occurred to me that the easiest course of action for any Front Bench speaker would be to ask the Government how they were going to respond to the 33 well argued recommendations contained in that report, and then sit down! The House might thank me for it. But that would have the disadvantage of glossing over one of the key criticisms of Project 2000: that it produces nurses who, at the point of registration, find themselves inadequately equipped to perform practical and basic nursing tasks on the ward. This widely held--but for a long time somewhat anecdotal--impression was backed up by the findings of a recent survey in which 59 per cent of recent registrants believed that more practice and less theory was required in the first year of the programme. In the same survey only 29 per cent of experienced staff in contact with Project 2000 nurses regarded them as either very well or quite well prepared in terms of essential practical nursing skills.
	It would be helpful to hear from the Minister whether the Government accept that this is an issue, and if so, what action they consider appropriate. In their document Making a Difference the Government undertook to consider EC directives which allow students to have more practical experience. I should be grateful if the Minister would elaborate on that as I was uncertain of the significance of that passage. In theory at least, the ratio of practical to academic teaching in pre-registration nurse training is 50:50. There is powerful evidence, however, that--as many noble Lords have emphasised--much of the practical training is debased by the lack of experienced nurses on the ward to act in a supervisory role, and by the sheer pressure of day-to-day life in a hospital. It is no good if a student nurse has to refer to a healthcare assistant for practical guidance. But that is what the current shortage of trained nurses can sometimes lead to. As I think every speaker has mentioned, the quality of the clinical placement is a vital ingredient in the learning process, and in that context I particularly welcome the recent joint publication by the NHS Executive and the Committee of Vice-Chancellors and Principals mentioned by the noble Baroness, Lady McFarlane, which recognises the importance of establishing close links between universities and NHS trusts. The aim should be to provide better support for students on placements; to give them a sense of belonging--which many of them do not have--and to ensure that those placements count for more, most notably by making them of longer duration. Much the same considerations apply to preceptorships for newly qualified nurses.
	To say that one is in favour of a diploma or degree based qualification is not, however, to say that entry into nursing should be limited to a narrowly defined group of people. One of the UKCC's main recommendations was that the NHS should try to attract student nurses from every type of background. I should be interested to hear from the Minister what plans the Government have to make nursing more appealing to members of ethnic minority groups who are under-represented on the register at present. I wonder, too, if he can comment on what seems to me an increasingly successful vocational route into the profession; namely, nursing cadet schemes--again these have been mentioned by a number of noble Lords--aimed at 16 year-old school leavers. As the Minister will know, cadet schemes have been championed in a number of hospital trusts and are proving popular. At Sandwell Health NHS Trust, for example, cadets are guaranteed a place at Wolverhampton University when they have achieved their NVQ level 3 and are ready to take a diploma. Another recruiting pool with considerable potential, mentioned by the noble Lord, Lord MacKenzie, and a number of other noble Lords, is that of healthcare assistants. Ways of fast-tracking healthcare assistants, especially those with considerable practical experience, through special nurse education programmes could be explored through the Accreditation of Prior Learning system. Can the Minister say whether the Government are willing to support such initiatives, and if so in what way?
	I mention these kinds of example to emphasise a point which many of us, I suspect, feel instinctively; namely, that the entry gate into nursing should be as wide as we can legitimately make it. There must be many young girls and boys who, when they leave school, know that they want to look after people but who may also feel that they are not yet ready to embark on a nursing diploma, still less a degree. Nursing should not shut out those individuals.
	I think that all noble Lords have recognised that, if they are to succeed, the style and content of nurse training programmes have to be tailored to appeal to individuals from a wide variety of backgrounds. Within reason the programmes must be flexible so as to deter as few people as possible who would otherwise have wished to enlist.
	In the end, the success or failure of nurse education programmes will be measured in three ways: the numbers joining such courses; the percentage of students who continue the programme to the end; and the perceived fitness for purpose of the nurses who qualify. I hope that the Government will recognise, and confirm to us today, that nurse education will remain central to the delivery of high quality healthcare across the country.

Lord Hunt of Kings Heath: My Lords, I am most grateful to the noble Baroness, Lady McFarlane, for securing this timely debate on such an important subject. She has had a most distinguished career in nursing. She was one of the first professors of nursing to be appointed. She was a true pioneer in the development of nursing education and practice and a towering presence in the nursing profession for many years. It is a particular pleasure for me to respond to her debate.
	As other noble Lords have said, it is also a great pleasure to welcome my noble friend Lord Morris of Castle Morris. He has been "cooking up" this debate for many months. I am sure that he will consider that the quality of all the contributions that we have heard this evening have been well worth the effort.
	We are discussing nurses, but over the past few weeks when the health service has been under tremendous pressure the contribution of all staff--doctors, nurses, paramedics, ambulance crews, community pharmacists, GPs and many more--has been absolutely outstanding. I take this opportunity to pay tribute to our wonderful staff, of whom nurses are often the most visible presence in all our thoughts.
	This debate has been a wholly positive one. It very much reinforces the Government's intent to pick up the point made by the noble Earl, Lord Howe; namely, to put nurses at the centre of all that we do and seek to do to modernise the health service. One has just to think about the potential of nursing in caring, in clinical areas, in leadership at a clinical level, in management and in new developments such as NHS Direct to appreciate that nurses are at the leading edge of the modernisation of our National Health Service. However, they remain true to the principles which the noble Baroness, Lady Cox, mentioned so eloquently today. The comments of the noble Baroness, Lady Emerton, also gave the full picture of what nursing is all about.
	As ever, I do not have a long time in which to respond to many of the points which have been made. However, I refer to the particular concern of my noble friends Lord Harrison and Lady Lockwood that nurses should be recognised and rewarded. As my noble friend Lord Harrison pointed out, Making a Difference set out radical plans for a new career framework linked to our proposals to modernise the NHS pay system and to provide satisfying and rewarding careers. The noble Lord, Lord Clement-Jones, mentioned the escalating use of nursing agency staff. I believe that ultimately the best way to attract full-time staff is to ensure that we have a proper career framework; that we address the issue of support for staff in stressful situations; that we are able to develop family friendly policies; and that we ensure that staff are protected from crime.
	As regards family friendly policies, I accept the responsibility of making sure that NHS trusts get the message in this respect. We have appointed champions in each region of the English NHS to develop good practice and to send out the kind of messages that the noble Lord has suggested we ought to send out.
	As regards crime, I could not agree more with the points made. It is intolerable that our staff, particularly nurses, are subject very often to abuse, both physical and verbal. We are determined through our zero tolerance campaign to do something about it. I know that the initiatives that we are taking have received a great deal of support from the nursing profession.
	When we consider the status of nurses and the wish to assure nurses of the key responsibilities that they have, I commend to your Lordships our appointment of consultants in nursing. That sends all the right messages of what nurses can achieve. It demonstrates the heights, if I can put it that way, that people coming into nursing may attain within a clinical area, and not necessarily by having to move into management posts if they do not wish to do so.
	Let me now turn to the issue of recruitment and retention. The noble Earl, Lord Howe, the noble Lord, Lord Clement-Jones, the noble Baroness, Lady Cox, and the noble Baroness, Lady McFarlane, made particular points about the issue of the shortage of nurses.
	Of course there is no hope of achieving what we wish to achieve in maintaining and developing services unless we can recruit more nurses to the health service. There is no doubt about that whatever. Our intent is that by 2002 we will make available up to 15,000 more qualified nurses and midwives. As your Lordships know, we have worked very hard to retain the nurses that we have.
	Of course pay is a factor in this. I accept the point of the noble Lord, Lord Clement-Jones. Last week in another place my right honourable friend the Secretary of State for Health announced above inflation pay increases for all nurses. Some 60,000 experienced staff nurses are to receive a 7.8 per cent increase. That is a very important signal to the nursing profession, particularly as this is the second year in succession where we have accepted the pay review body's recommendations in full.
	Our current nurse recruitment campaign is proving that the NHS is turning the corner in this area. Almost 5,000 nurses have returned to employment in the NHS or are preparing to do so after completing refresher training. Even more encouraging is the fact that recruitment to nurse training at the moment is very buoyant. The Government are committed to achieving 6,000 more nurse training places by 2002. Applications for the diploma programmes have risen by 79 per cent and there has been an increase of 24 per cent in the numbers taking up degree courses.
	The issue of degree versus diploma is always interesting. I agree with the noble Earl, Lord Howe, that there is a place for both and that we need to make the entry gate as wide as we possibly can.
	I was interested in the comments of my noble friend Lady Lockwood when she raised the issue of attrition rates. My figures show that they are around 15 per cent. We have ironed out some of the anomalies to which my noble friend Lord Morris of Castle Morris referred. Of course 15 per cent is lower than some of the figures that we have heard during the debate. None the less, there is no room for complacency. Clearly we must do all that we can to get those figures down.
	When we think of diplomas and degrees we come to the issue of how one balances academic qualification against the need for access to nurse training for as many people as possible. I was particularly pleased to hear of the examples of good practice that many noble Lords raised tonight. My noble friend Lady Lockwood, for instance, spoke about Bradford's pioneering achievements--and we have seen a high increase in the number of applications to become nurse trainees from members of the Asian community. A number of noble Lords referred to Wolverhampton and the link with Sandwell Health. My noble friend Lady Warwick referred to new vocational pathways, part-time courses, access and cadet schemes. There were other examples. I was delighted, for instance, that the University of Central England based in Birmingham achieved an honourable mention. I can say to the noble Earl, Lord Howe, that we will spread the message about the successful schemes. There is much to learn there.
	I am aware of concerns in relation to student bursaries. Let me make two points: first, in regard to anomalies, to which a number of noble Lords have referred; and, secondly, in regard to the administration of the schemes in the last round, a point raised by the noble Lord, Lord Harrison. As far as concerns the anomalies in relation to student bursaries, I propose to undertake a review of student support which will report within 2001. I am also determined to ensure that we iron out the problems that have occurred over the past few months in relation to the administration of bursaries.
	I now turn to issues of nursing practice. The noble Baroness, Lady Masham, made some very interesting points on that. To start with, we need to reflect on the many important new areas in which nurses are leading change--clinical governance, evidence-based practice, skill mix changes and NHS Direct. I never tire of reminding your Lordships of the success that NHS Direct is having. It is, of course, all down to experienced nurses and the advice that they are giving to thousands and thousands of people.
	Of course there will always be concerns about the changes that have taken place in nursing practice and nursing management. The noble Baroness, Lady McFarlane, referred to her appearance in the Lord Mayor's Show. I surely did not hear a cry from her of "Bring back matron". We must recognise that we have some very dynamic, expert, professional nurse managers and leaders in the health service, who are well able to handle the awkward questions posed by the noble Baroness, Lady Cox. While I understand the nostalgia for the matron's round and all that that meant, we should pay a great deal of tribute to the quality of nurse leadership that we now find in many of our hospitals and other areas of the health service. It is no coincidence that if one looks at the number of general manager posts occupied in the health service, nurses supply a significant number of people to those posts. That is a reflection of the quality that they are bringing to leadership in the health service.
	There have been many reports on nurse education over the past 20 or 30 years. The noble Baroness, Lady McFarlane, referred to some of them and to some of the shortcomings, particularly in tackling the new challenges that we all face. She referred to many of the achievements and some of the problems of Project 2000. My noble friend Lord MacKenzie made some very pertinent points and I was particularly interested in the comments of the noble Earl, Lord Howe, which provided information about the background. I agree with him when he stresses the role of the universities and the essential contributions that they now must make to nurse education.
	We have listened carefully to the concerns about the current arrangements for nursing education. In Making a Difference the Government set out their priorities to improve nurse education, to tackle concerns that student nurses do not always acquire the necessary practical skills while ensuring that they are fully prepared for their future leadership roles. There will always be a balance between clinical practice experience and the need for academic vigour. It is important that we get the balance right.
	With that in mind we have set out a three-point plan: to provide more flexible career pathways into nurse education; to increase the level of practical skills; and to deliver a nurse education system more responsive to the needs of the NHS. Under this new model universities will develop systems which will recognise the existing learning and skills, for example, of NHS healthcare assistants with vocational qualifications, enabling them to fast-track nurse education.
	I accept the point made by my noble friend Lord MacKenzie about the need to encourage healthcare assistants, first, to have access to NVQs and, secondly, it is hoped, to fast-track them through to full nursing qualifications. I should like to say to the noble Viscount, Lord Bridgeman, that of course we accept that there is a need to review the status of healthcare assistants and we have recently announced a review to do that.
	I believe that the new model that we are developing will provide more opportunities for people from all walks of life to deliver front-line care in the NHS as qualified nurses. There will be a focus on the development of practical skills earlier on in training, and a focus on better clinical placements, with support for students from trained nurses with up-to-date teaching skills and from teachers who are actively practising nurses.
	I accept the important point made by my noble friend Lord Morris of Castle Morris on clinical placements. We have already issued guidance on introducing long-term practice placements. Undoubtedly the new model of nurse education will bring in a stronger practice focus through early practice placements and links between education and employment. In response to the comments of the noble Viscount, Lord Bridgeman, I support the view that students should also be able to gain experience in the independent and voluntary sectors as a part of their training. More generally, we need to work very hard to ensure that clinical placements are as effective as possible and that those students being so placed receive the support they need in what undoubtedly can be stressful situations.
	I shall now turn to the arrangements for dealing with nurse education at the national level. In the wake of Project 2000 there has been some criticism that the NHS effectively handed over responsibility for nurse education to the university sector. Because of that, we have announced the creation of a new education and training unit within the NHS Executive to strengthen delivery and quality assurance of education in England, from lifelong learning for the wider NHS workforce to continuing professional development.
	The intention is to achieve a far more consistent approach to education and training. However, that neither ignores nor undermines the fact that it will require a strong partnership between the NHS, the regulatory bodies and the universities. I should like to reinforce the message given by many noble Lords today about the need for that partnership. My noble friend Lady Warwick stressed the need for partnership with the universities. The noble Baroness, Lady Emerton, spoke of the need for partnership with the NHS. I very much look to chairs and chief executives of trusts in the NHS to ensure that that happens.
	NHS employers need to know that, wherever nurses are trained, they have acquired the same level of practical skills at the same stages in nurse training. Similarly, the regulatory bodies need to know that nurses meet the standards for entry into the profession and the universities need to know that nurses are fit for the academic award. We want to see a streamlined system of quality assurance to assess fitness for purpose, fitness for practice and fitness for award.
	The Department of Health will take the lead on assuring the quality of NHS-funded education through a contract with the new quality assurance agency, working in partnership with the regulatory bodies, the universities and the NHS. I hope that this assures my noble friend Lord Morris of Castle Morris that we will ensure that the most effective teaching by well-qualified people will be undertaken. None of this affects the principle that the regulatory bodies have ultimate ownership of setting and monitoring standards for the purpose of registration, but it does mean a more coherent and collaborative approach to quality assurance.
	I should like to turn to regulation. Almost a year ago the Government announced their response to the review of the Nurses, Midwives and Health Visitors Act 1997 and an acceptance of the recommendation to create a new nursing and midwifery council. Since then, we have worked closely with all the health professions. We fully support professional self-regulation, but it must be open, transparent and accountable. Furthermore, we are committed to strengthening the regulatory framework with a new smaller, strategic UK-wide council.
	As regards the order, perhaps I may assure the noble Baroness, Lady Emerton, that we will engage in open consultation. The initial consultation is due to commence shortly with a further three-month period for consultation prior to the order being laid before Parliament.
	The clock is against me. I hope that I have assured noble Lords that the contribution of nurses, midwives and health visitors is both recognised and valued. These professions are undoubtedly the backbone of the NHS. They are leading the way towards modernisation. They are an enormously committed workforce for which any other employer would give an arm and a leg. We owe it to them to support them in what they do, to ensure that they are well rewarded, that they have a proper career structure and that, as the regulation and training of the profession is modernised, so we will support them in these new challenges.

Baroness McFarlane of Llandaff: My Lords, time is against us in this time-limited debate. However, I should like to thank everyone who has taken part in what has been a wide-ranging and informative debate. I am sure that we shall all leave the discussion with new vistas on the whole aspect of nursing education and practice.
	The experience and expertise of the House shows itself marvellously in a debate of this kind. Where else would we have two university chancellors talking about nursing courses in their universities and a view from an independent provider? Not least, we have heard the four nurses in the House contributing from their personal experience. However, the most eloquent contributions today have come from the consumers, those who have experienced nursing care of various qualities. I should like to thank them for their contribution to our deliberations. That will send us away with a greater determination to ensure that nursing education and practice is improved in the interests of the consumer.
	I should like to thank the Minister for the way in which he answered so many of our questions and for the generous personal remarks that many contributors have directed to me. I beg leave to withdraw the Motion.

Motion for Papers, by leave, withdrawn.

Teachers

Baroness Perry of Southwark: rose to call attention to the importance of teachers; and to move for Papers.
	My Lords, I am pleased to have the opportunity to explore the issues surrounding teachers and the teaching profession and to pay tribute to their importance to the happiness and prosperity of our country. I look forward very much to hearing the maiden speech of the right reverend Prelate the Bishop of St Albans and to the many other speeches from noble Lords.
	I do not intend to offer emotional tributes to our wonderful teachers, although such tributes are well deserved. The teachers to whom I speak are tired of fine words, outweighed as they feel they have been by harsh words which have damaged their professional esteem and sense of worth. What they look for now are fine deeds from the Government.
	The Government have concerned themselves with issues of importance to teachers. I am quite sure that their intentions are to raise the status as well as the performance of teachers and I applaud some of the measures which have been taken. I was long an advocate of the General Teaching Council and look forward to hearing the speech of its chairman, the noble Lord, Lord Puttnam, in this debate. I am sorry that the GTC has only advisory powers, as I believe it would have meant a great deal to the teaching profession to have been trusted to manage their own affairs, but a step in the right direction is better than no step at all.
	I also very much applaud the teaching award scheme. Some of the achievements of teachers which are celebrated in the scheme draw the public's attention to excellence which is more widespread than the few lucky recipients who win this award would indicate.
	When I say that excellence is widespread, I speak from experience as a former teacher and trainer of teachers and as a member of Her Majesty's Inspectorate for 17 years and chief inspector for the last five of those years. I know that daily in our schools teachers who love their job and enjoy the company and stimulus of their pupils help to raise the standards of achievement in ways for which the whole nation should be deeply grateful.
	Let us just look at the evidence. Teachers are, by any criterion, doing a superb job. The performance of pupils--the most important criterion--has improved steadily over the past decade since the performance tables were first published. Teachers responded magnificently to a clear message from government about the desired outcomes from their work.
	An analysis of inspection reports over the past 15 years in selected subjects shows that teaching standards themselves have steadily improved. Parents too are happy with teachers. In a recent poll conducted for The Times Educational Supplement by FDS International, nine out of 10 parents rated teaching standards as good, very good, fairly good, and an even higher percentage rated their own children's teachers as good and very good. In a Guardian newspaper ICM poll, teachers were rated in high esteem, ahead, I may say, of university lecturers, vicars, policemen, politicians or journalists. Any commercial enterprise would be very happy with such results, as would all its shareholders and stakeholders. So why is it that we face a teaching force approaching a crisis in morale, with severe shortages in teacher supply, difficulty in recruitment to senior posts and teachers leaving the profession in ever greater numbers each year? Between 1993 and 1998 the number of teachers leaving the profession for other employment increased by over 50 per cent, from 2,000 in 1993 to more than 3,000 in 1998.
	Despite the excellent recruitment campaigns of the Teacher Training Agency and the Department for Education and Employment, school-leavers are receiving negative advice about teaching as a career, not only from their careers advisers but, much more worrying, from the teachers themselves. One school-leaver reported to researchers from Loughborough and Hertfordshire Universities:
	"I was told by my own teachers not to waste my brain on teaching".
	Students in training as teachers find the same negative attitudes. More than a quarter of the students interviewed for the same research project said that teachers in the schools where they had undertaken their teaching practice during their course had been negative about their job. One teacher who recently left service in the Lambeth local authority to return to journalism sums up in a recent article the reasons why she left the profession in this way:
	"too much regulation, too little flexibility, too much paperwork, and the frustration that no one seems to be listening to teachers any more".
	Everyone knows that raising standards in education rests almost entirely on the performance of teachers. The quality of education which pupils experience is dependent on how the teacher plans, organises, guides, leads and indeed inspires. In 1985 Her Majesty's Inspectorate published a booklet in its Education Observed series entitled Good Teachers. The inspectorate drew on its century-and-a-half of observations of teachers in thousands of schools and hundreds of thousands of classes to describe those characteristics which constitute the good teachers we all admire. It says:
	"they are able to command the respect of their pupils not only by their knowledge of what they teach and their ability to make it interesting, but by the respect which they show for their pupils, their genuine interest and curiosity about what pupils say and think and the quality of their professional concern for individuals".
	What is described here is the creative process between teacher and pupil which lies at the heart of successful teaching. This country has long been admired for our creativity and our creative success. We have a proud record of Nobel and other international prizes, and we were until recently the world's largest producer of patented inventions. On my recent visit to the Millennium Dome, I was delighted to see a section devoted to British creativity. That display records that, despite the low output of British films, we win one-third of all film Oscars. We also produce one-third of the world's store of computer games. Britain has produced Mazda cars, I-Mac and Christian Dior. British architectural design is celebrated around the world. But the nature of our educational system and its creativity are the essential ingredients in this creative result.
	After many years travelling around the world looking at other educational systems, I have no hesitation in saying that the key characteristic of British education has been our highly creative classrooms. They contrast very often with the rote teaching and learning which go on in so many other countries. But to maintain this creativity, two things are necessary: first, that teachers have freedom to exercise their professional judgment in the classroom; and, secondly, that they feel they enjoy the trust and confidence of the society in which they work. My sadness today is that in both these areas the creativity of the teaching profession is being severely damaged. That, I believe, is the reason why we have a crisis in morale and so much difficulty in persuading the brightest and best of young people to become teachers.
	A report by the Teachers Supply and Retention in London Project, to be published next month, found that the main reasons for those seeking new jobs and leaving the profession were "Room for Initiative" and "Scope for Creativity". They rated these well above the opportunity for improved pay or working hours.
	Let us take a few examples of the attacks on teachers' professional activity of the past two-and-a-half years. My first example is performance pay. Most of us have no problem with the idea that those who are successful in their work, whether teachers, salesmen or journalists, should be able to rise up through their profession and receive greater rewards. The teaching profession itself has always recognised that there is a hierarchy of promoted posts and that those who are good at their job get promotion. They feel threatened, not by the idea of performance pay, but by what they perceive as a scheme which assesses them on limited, mechanistic factors which they feel, rightly or wrongly, have little to do with the reality of their professionalism and into which they will have limited input. At the point of qualifying as teachers, graduates must now be assessed on no fewer than 67 items of competency, none of which has anything to do with the creative process between teacher and taught. Yet it is very often through creative activities that disadvantaged and disaffected young people are encouraged to enter more formal learning and improve their performance overall.
	My next example is the literacy and numeracy hours. These have been widely approved as a direct input into raising these two key skills. Many teachers have undoubtedly found it helpful to have guidelines--excellent guidelines--on how to help their pupils in these basic skills. But creative and successful teachers have already found ways to raise children's literacy and numeracy standards to a high level, and they, and the schools in which they teach, find it both inhibiting and de-professionalising to be made to follow specific guidelines. For a high achieving teacher and a high achieving school, mandatory guidelines on how to teach, by five- and 10- minute intervals, are anything but helpful. Indeed, they destroy that very creativity that is the mark of the successful classroom.
	Many teachers also perceive central government's intervention in the in-service training of teachers and of heads as an attack on their professional autonomy. The decisions about when, how and in what areas further professional training is taken has for decades been a prerogative of the professional teacher in consultation with her or his colleagues. As ever more money and more activity are now diverted to specific government-inspired programmes, the freedom of teachers to follow their own professional path is becoming limited. Equally, the ability of the individual school to make its own decisions about priorities in staff development, which was one of the most exciting developments of the 1980s, has been severely eroded. It was in the course of an OECD international conference that I first heard the phrase,
	"the school is the living cell of the body educational".
	I believe that to be absolutely right, and it is at the level of the individual school, through the leadership of the head and the creativity of the staff, that a revitalising of the whole body educational can best be accomplished.
	In my experience as a manager of people, I learnt one lesson--the best decisions are made by the people who must implement them at the working level. The quality of decision making becomes progressively worse the further it is removed from that working level. Central government should learn to walk with a very light step over the professional creativity which is generated in teams of teachers, who feel a deep professional commitment to their school and their community of pupils.
	I therefore read with sinking heart headlines like,
	"Ministers to control elite new teachers",
	describing a scheme unveiled by the DfEE two weeks ago. An external contractor will select 1,000 new graduates each year, to be paid a £5,000 "golden hello". As one recruitment analyst commented,
	"the current open system of recruitment, where applicants are free to apply to the schools of their choice, and schools are free to appoint the best applicant is now replaced by a system where the government decides, through its appointed consultants, who are the top thousand graduates each year. Schools must then bid to the DFEE for such super teachers to be appointed to their schools".
	No wonder the head of one large community college commented:
	"the real concern is the feeling that the government is not recognising our professionalism; so much is now being dictated from the centre by the civil servants and special advisers".
	Finally, I come again to the question of fine words. Enormous publicity has been given to that tiny minority of the profession who fall below acceptable standards. Any profession, any job, any community of workers will have its below average members, and indeed its failures, who can and should be dealt with in quiet and private ways. But I have never understood how it is thought that one can make people better by telling them that they are bad. Such public criticism damages the self-esteem of the good teachers and does nothing to improve the weak. What I do understand is that when public figures speak, with all the resonance that their remarks command, they must speak about the good teachers. When they do so, they will reflect the feelings of those nine-tenths of parents who see their children's teachers as good or very good.
	The teaching profession represents the highly skilled and highly trained army with which we fight disadvantage and inequalities in our society. No army can go out to win unless it has the full confidence and support of the society for which it fights. My appeal to the Government today is to show in word and deed a confidence in the teaching profession. If we are to continue to enjoy the professional dedication and commitment of teachers, we must learn to respect their autonomy and to allow them the magic of creativity and, in sum, we must learn to trust our teachers. My Lords, I beg to move for Papers.

The Lord Bishop of St Albans: My Lords, I count it a privilege to be able to speak in this debate because the subject is very dear to my heart. As I go around my diocese and elsewhere, I meet teachers who seem to be almost entirely exhausted. They have been drained of life and drained of energy. And why? It is because every detail of the curriculum seems to be dictated nationally and then every detail changed with bewildering rapidity. So, if you have no control over the detail and no control over the rate of change, you cease to see any value in what you are trying to do. You are transformed from being a teacher into being a technician.
	The results of this major shift in the educational style of our country are beginning to show. There is no need to repeat the numbers of teachers leaving the profession; nor do I need to say anything more about the struggle to recruit suitably qualified teachers. But I think of those teachers I know who are working unbelievably long hours--weekdays and weekends--at considerable cost to their families and social lives; and ultimately at the cost to the refreshment of their own minds and souls, without which their teaching is bound to wither.
	That relentless pressure, and what seems to be an obsessional desire for continuous change, simply does not take account of what teaching is like. Teaching is partly a craft; and in common with other crafts, you can get better only as you learn from your mistakes and try again. But when continuous change is neurotically driving everything, learning, and learning to improve, do not stand a chance. But it goes even deeper than that because every single pressure group in the country now seems to believe that it has the right to dictate what should be on the curriculum. The curriculum in schools is now overloaded to breaking point. As a result, those pastoral and spiritual matters, which actually underlie most teaching, are pushed to the margins and beyond. Gradgrind, heaven help us, has won.
	So what happens to the child who is bullied? What happens to the child who is the victim of abuse? What happens to the child who is chronically ill? The answer, of course, is that teachers, as always, try to cope. They call on deep personal and spiritual resources--perhaps their belief in God; their belief in love; their belief in the worth and value of every individual child. They try to put into practice that skilled companionship mentioned in our previous debate. Meanwhile, with a resounding thump, yet another set of directives arrives: more measurement, more accountability. The spiritual driving forces which took teachers into their vocation in the first place are smothered by endless torrents of documentation.
	So, teachers feel battered by government--whichever party is in power--and battered, sometimes literally, by parents. I cite the Ofsted system as an example. There are, as noble Lords will know, a series of questions for parents to answer during an Ofsted inspection: questions such as, "Do you feel the school encourages parents to play an active part in the life of the school?"; or "Do you feel the school achieves high standards of good behaviour?" Your Lordships will know that there is not a single question which asks parents about their role. Parental rights are assumed to exist and to have the highest priority, but nothing is said about parental responsibility.
	Teachers, the Ofsted system seems to assume, have few rights if any, but, in contrast with parents, are asked to bear total responsibility. I want to suggest that every Ofsted questionnaire should have a section for parents to answer, about themselves. I should like them to be asked, "As parents, you have the primary duty and responsibility to educate your child. What do you feel you could or should do to assist your child's school in its task?" I recognise that the question is a little sharp and I know about home-school agreements--I welcome them--but I look for a shift in the balance; a shift in the culture of education from one that appears to be based on consumerist rights to one based on partnership and co-operation.
	But I want also to draw attention to one particular sector of education where the problems have become especially acute--and that is in the small rural primary schools. Not only are they set in a context which, itself, is undergoing massive change; they now consist of handfuls of teachers and governors working under the most intense pressure to hold everything together. The heads in particular are supposed to keep up with every curricular change. They stoke the boilers--I exaggerate, but only just--and carry, in many cases, a full-time teaching load. They need a break; and what they look for, among other things, is a budgeting process which takes account of the special costs involved in providing education in remote areas. Where is their voice being heard? I echo a phrase in a previous speech: no one seems to be listening to teachers any more.
	I believe that teaching is not just approaching a state of crisis, but is actually in one. If the pace of change does not slow down, if the culture does not alter, and if the voice of rural schools is not heard, the educational heart of our country will be broken. This crisis requires a careful response, in which qualities such as humility, trust and a willingness to listen should be high on the agenda.

Lord Haskel: My Lords, it is my privilege, on behalf of the whole House, to congratulate the right reverend Prelate on his maiden speech--the first maiden speech from the Bishops' Bench of the new millennium. What a well-informed and thoughtful speech he gave us. We should not be surprised. The right reverend Prelate brings to this House a lifetime's experience and knowledge of education and teaching. As well as being an ordained minister, he has been a teacher, an author, a director of education for the diocese of Hereford, a school governor, a college governor, and a member of two local authority education committees. What a rich depth of experience he brings. We look forward to hearing from the right reverend Prelate often and to benefiting from his wide knowledge and experience of teaching.
	The right reverend Prelate has chosen his subject well: the importance of teachers. If we allow them, teachers have an enormous impact on our lives, and not only when we are at school or when we are students. If we are lucky and perceptive enough we come into contact with people who teach us valuable lessons at all stages of our life--lifelong learning in deed and in fact.
	I am grateful to the noble Baroness, Lady Perry, for moving this Motion. It gives me the opportunity to speak about four people who have taught me valuable lessons, not only at school but in life, and to honour them by telling your Lordships about them. I apologise to noble Lords who may find my remarks anecdotal and a little sentimental, but good teachers use anecdotes, and, frankly, I am sentimental about my four teachers.
	At age 15, I had an English teacher called Mr Boggis. He was a man of the cloth and delivered little sermons with his lessons. He taught us a lot about morality. But the lesson I remember best was based on a photograph that he took in Canada. It was a winter scene with a country road covered in deep snow and ice. The tyre tracks were at least a foot deep. At the side of the road was a notice which said, "Be careful which rut you get into because you will be in it for the next 25 miles". It was a powerful bit of teaching, using an anecdote which we could all see and understand.
	Music has been a great joy in my life. I trace that back to Sir John Barbirolli. It is not what he taught me, but something that he did. When I was a student in Manchester, he had come from America to take over the Halle Orchestra. In a wonderful piece of imagination he allowed students who could not afford to go to concerts to attend certain rehearsals. Like others, I sat in because it was warm and dry and a nice place to go. But I soon became interested in the music because of the way he explained to the orchestra how he wanted passages played. He was an inspiration, explaining his reasons for different speeds and rhythms. He said what he wanted; but also why he wanted it. Surely that is the key to an inspirational teacher.
	In the late 1960s I was running a textile business. At that time the fashion in management was accountancy. Clever and creative accountancy equalled good management. My problem was to improve the performance of the business by speeding up delivery, giving better service and improving quality--problems that accountancy could not solve. A lone voice was saying that performance could be improved by what we would now call "empowering" people through training and consultation. The voice was that of Wilfred Brown. He was putting his ideas into practice at Glacier Metal, and he was generous enough to teach others his methods of improving performance and breaking down barriers. He allowed me to do what would today be called a benchmarking exercise. Perhaps that was because I was not a competitor, but what he taught me gave my company a competitive advantage over many years. He was my business teacher, my guru. He was forward-looking, generous with his time and enthusiastic about his ideas--all signs of a good teacher. Of course, Wilfred Brown was a Minister in the Labour Government of the 1960s. He renewed my interest in the Labour Party. And it was through him that I met my political teacher.
	In the late 1960s and early 1970s, economists were saying that the price of a strong and sound economy was greater social division and more inequality. Indeed, some still say that. To me, that only encouraged divisions between workers and employers, to the obvious detriment of the economy. Enter the final teacher whose memory I should like to honour--John Smith. He turned the economics of division on its head and taught that decency and fairness went hand-in-hand with a sound economy. He taught us that fairness and equality of opportunity were the basis of a good economy, offering people the opportunity to give of their best. It encouraged change over tradition. His teaching increased our efforts to bring business and the Labour Party together. Those decent values not only characterised the man; they are also at the centre of the economic and social policies of today from which we all benefit.
	Those are the four important teachers whom I should like to remember. They taught self-confidence and morality. They inspired good practice and decent values. They were rich and lasting lessons. I benefited from the creativity about which the noble Baroness, Lady Perry, spoke.
	I doubt that my teachers were conscious of the impact they were making at the time. For their own personal reasons, they taught with generosity, imagination and thoughtfulness. I can only honour teachers by telling the House about them--the "fine words" referred to by the noble Baroness, Lady Perry. The Government can honour them by giving them what they want and deserve: recognition, encouragement and support for the important work they do.

Baroness Sharp of Guildford: My Lords, I join others in congratulating the right reverend Prelate on his maiden speech, which I found wise and thought-provoking. I look forward to further contributions that he will make to debates in this House.
	I should like too to congratulate the noble Baroness, Lady Perry, and thank her for initiating this important debate. She made an excellent introductory speech, in which she summed up so many of the problems that confront us today on this issue. The subject of the debate is the importance of teachers. It took me back to a work that I read in the 1970s and which the noble Baroness will know; namely, Michael Rutter's first major research report, which I believe was entitled 400,000 Hours. It dealt with the performance of a series of schools in and around Greater London. It was published at a time when it was generally said that performance could be explained entirely by income and social class. Michael Rutter showed clearly in his study that schools mattered--and not only that schools mattered: teachers mattered. The more deprived the area, the more the teacher mattered. For a child, it is self-image and self-aspiration that count so much in achievement. In deprived areas teachers are vital in setting the self-image of a child and making it believe that it can go further and achieve a little more.
	If teachers are so important why do we not nurture and trust them to a greater extent? Like most people in this Chamber, I know a good number of teachers. I am a governor of a small primary school in the north of Guildford. As numeracy governor, on Monday evening together with all the teachers and the head teacher of that school I attended what was called a twilight training session. We had a session with a trainer from 3.30 to 5.30 on the numeracy hour. I found it interesting but I had come to it fresh. Those teachers had been teaching all day long, and most of them then went home to families with young children. They had to feed the family, supervise homework, get sports kit ready and do all the things that mums have to do. On top of that, they spent another two hours marking work that had been done that day. I noted that the top class teacher I met took home two sets of 30 books to mark, and prepared lessons for next day.
	The job involves long hours and is not very well paid, although pay is better than it used to be. It is desperately hard work, and to an extent the task is becoming harder. The school of which I am a governor is in the more deprived part of Guildford and has always had a number of difficult children, but every year there are more and more disturbed children who disrupt the classes. If one asks the teachers why they do it, they will say it is certainly not for the money. They really do not know why they do it except that it is for the children. They love their classes and get real satisfaction from raising the sights of children and seeing them achieve that little bit more. That is the creativity of which the noble Baroness, Lady Perry, spoke earlier.
	Yet morale is rock bottom. Why? At the moment, however hard they try their reward seems to be further tests, targets, reports to be written and forms to be filled in to justify what they are doing and why. League tables are fine if the school is in a nice middle-class area with supportive parents and is at the top. One gets a real kick from being at the top of the league table. But value added tables, which are the ones that count in my school, are in their infancy. Governors see them but they are not published. In a small one-form entry primary school, which can provide the support and help that so many children from disturbed backgrounds need, it is all too easy to have three disruptive boys in one class who can reduce one's performance in the league table in no time at all.
	To cap it all, the Government propose to move to performance-related pay. Does the Minister not understand that when one does not do the job for money the reward is the collegiality; that is, the sense of being part of a team and working together to achieve common goals? For that reason, many one-form entry schools will not be bidding for performance-related pay because effectively it spoils the team and destroys that collegiality. The Government may find that they have gone one step too far and have destroyed the one thing that holds the profession together.
	I finish by quoting from a speech given last year by the Prime Minister to the National Association of Head Teachers:
	"I know that ... what we are trying to do ... will succeed or fail on the efforts of individual teachers in every classroom in the country".
	The Prime Minister knows what we mean, but there is a great danger that at the end of the day, as a result of the measures that the Government are pushing through, their plans will be undermined by a failure to recruit and retain the teachers that they need. As the noble Baroness, Lady Perry, made clear, we must trust our teachers and respect their professionalism.

Baroness Massey of Darwen: My Lords, I am grateful to the noble Baroness, Lady Perry, for raising such an important issue and sharing some, but not all, of her concerns. I, too, congratulate the right reverend Prelate on his incisive contribution. For about 20 years I was a teacher mainly in secondary schools but also in pre-school settings. I became a teacher because the importance of teachers was clear to me from an early age. As a working-class child from the north of England, certainly I would not have gone to university had it not been for the inspiration and guidance of teachers. Their talents were not simply the imparting of knowledge and academic excellence but their communication skills and attention to positive relationships with pupils.
	As the Lebanese philosopher Kahil Gibran said, the valuable teacher is one who can lead you to "the threshold of your own mind". I, too, am a school governor of a London primary school where over 50 per cent of the children receive free school meals. That gives an idea of the level of deprivation. Yet that school performs extremely well in the league table for academic achievement--better than many middle class schools in the same area. Why is that? Under the visionary leadership of a head teacher there is a commitment to purposeful learning, motivating children and an emphasis on personal, social and health education which contributes to the positive ethos of the school. Teachers do not work in isolation but as a team with school helpers from the community. Parents, too, are involved by the school in their children's education.
	The school promotes a culture of achievement in both academic and social terms and children of many cultures, faiths, languages and abilities are encouraged to reach high standards. Therefore, two important aspects go together: good teaching and good school management. Teachers in that school are not negative about their jobs and are creative. They were years ahead of the literacy scheme referred to by the noble Baroness, Lady Perry, and have simply built on it.
	School governors as well as schools are deluged with information, and I recognise that that is daunting. I was encouraged, however, to receive recently two pieces of information. The first was a letter to chairs of governors from David Blunkett stating that the funding available to schools this year and next would be increased by £1.1 billion, with an extra £50 million from DfEE resources to support school budgets, an extra £500 million grant and £450 million to support pay increases for teachers. There was also ring-fenced money for nursery provision and class size reduction.
	The second piece of information was a document to governors from the Qualification and Curriculum Authority and the Centre for the Study of Comprehensive Schools. That document discussed performance data and the ways that that could be used by governors to set targets. It included questions to ask schools, action to take and suggestions for monitoring change. All of those matters are essential in raising standards and encouraging dialogue between governors and their schools. I believe that a commitment to excellence for the many, not just the few, through a combination of pressure and support will increase levels of learning and teaching. It also demonstrates an emphasis on the importance of teachers.
	Recently, I asked a number of friends who are teachers or headteachers about their response to the Government's strategy for education. They complain about paperwork and about difficulties in recruitment, but point out that newly qualified teachers may find some schools difficult places in which to start their careers; hence the case for improvement in schools. However, they are unanimous in believing that performance management, target setting and curriculum guidance will improve standards for all children.
	Teacher satisfaction comes from seeing children do better than expectations and perform well. Teachers know that they are important in this. Policies at national and local level, strategies and guidelines which support good teaching are vital to success. They need not be constraining. A recent Ofsted inspection in my school consulted parents, teachers and governors and confirmed our confidence in the school.
	Research quoted by the noble Baroness, Lady Sharp, from the Institute of Education--it was actually called Fifteen Thousand Hours--conducted in the late 1970s demonstrated the difference schools can made to children's lives. I believe that such research would be relevant today. Teachers are important and all children are entitled to effective teaching and well-managed schools.

Lord Pilkington of Oxenford: My Lords, like the noble Baroness, Lady Massey, I came from a working-class family in the north and I owe everything to the teaching that I received. I have spent the whole of my adult life teaching, first, in an African boarding school, then in a secondary modern school and then in schools of which the Minister may not approve. However, I can assure her that her noble colleagues were not an easy task to teach in their youth!
	All of us can accept the truth of my noble friend's Motion; the importance of teachers. But because of my experience, I must be realistic. I am not accusing other speakers of failing to do so, but when one has been at the chalk-face, realism and practicality are high in one's sense of priorities--and even, at times, is a certain criticism. Because of the importance of teaching, it is crucial that only the best fitted for the role are admitted to the profession. As any practising teacher knows, above all they must be in command of their subjects, whatever they are.
	In my experience, disorder and failure often spring from a teacher's weakness in the subject he or she is trying to teach. Pupils are inspired and enthused, and are orderly in consequence, only if their teacher has a knowledge and depth of understanding of his subject. In that context, it would be useful, although costly, if the Government could consider introducing subject teaching at pre-secondary level. It is hard to expect teachers to give imaginative teaching of mathematics to pupils under 11 if the limit of their own achievement was a grade C at GCSE. I accept the Government's initiative in imposing more demanding tests on trainee teachers.
	However, if we are to fulfil our duty to our children, we must attract talented graduates to the profession. That means increasing the prestige which teachers enjoy. In the end, it will, I fear, mean paying them more. True, they are paid more than they were, but a graduate teacher will receive less than a secretary. The difference between the salary of my eldest daughter who teaches in Tower Hamlets and that of her sister who works in advertising is about £15,000 a year--and my eldest daughter does a more demanding task.
	The top priority for the new General Teaching Council is to give attention to the need to give the profession the respect, importance and prestige that other professions enjoy. Following the praise that has been given to teachers, I must enter a small note of criticism. Of course respect can only be given if it is earned. And we must recognise that, so far as concerns society, in part teachers have suffered from the fact that in their training from the 1960s onwards many teachers' colleges emphasised the most progressive choices, practices and theories.
	I accept that teaching must be creative and none of us would support teaching by rote, but the methods which prevailed in the 1960s and 1970s essentially rejected many of the previous structures and followed the ideas of American professors of the early century such as Dewey which suggested that learning should be caught rather than imposed. At the turn of the century in his university school in Chicago, Dewey taught mathematics by playing at shops in school rather than doing whole-class teaching. Those ideas may work in small classes of children of university lecturers, but they are less effective in a class of 30 in Bethnal Green.
	In a sense, a balance was found on the continent. We must pay regard to the continent because its teachers enjoy greater prestige than do ours in this country. It is not always teaching by rote and they were less touched by the more extreme progressive methods which governed some English teacher training colleges in the 1960s and 1970s.
	The emphasis on greater informality and lack of structure was paralleled by a general development in society which has made the teachers' task more difficult; the collapse of hierarchy in the 1960s and 1970s. That had an effect, which we and the General Teaching Council must recognise, on the way in which society regarded teachers. We have ground to make up. Things are now changing and I appreciate that the Government and the Secretary of State recognise the problem and have tried to do something about it. However, it is important that teachers are trained to deal with the situation that they face and not moulded in audacious and revolutionary theories which are not sustainable in the tough world of the classroom.
	Inspection is crucial and I strongly support the work of Ofsted. But it is also crucial that inspectors are carefully chosen. They must not be teachers who have fled the classroom. In parts of east London, they are known as the men in grey suits who sit at the back. Furthermore, I have grave doubts--and I echo those of other speakers--about whether the Government's tendency to feed out ever more documentation from the centre has much effect on improving standards. Too many trees die in vain.
	There is a lot to do, but in the end an important step is to give individual schools more responsibility both financial, which is how they pay their teachers, and organisational, which is how they appoint their teachers. When that is done and the close collegiality which exists in schools is created, good schools are created. I have bored noble Lords with my praise of the London Oratory school, but it is an example of what can be achieved. That school in a tough, rough area of London does not just select the best. It has produced a transformation with its use of organisation and the reality with which it has faced its task.
	It can be done. We are not in an antagonistic situation. Teachers have problems to overcome and we can help them. They are not all good--they need patting on the back and occasionally they need a little rap over the knuckles, although it is forbidden.

Lord Smith of Clifton: My Lords, in congratulating the noble Baroness, Lady Perry of Southwark, on introducing this important and overdue debate, I want to make three points. One is general and two are specific. My general point revolves around the fact that during the past two decades successive governments have relentlessly pilloried school teachers as a failing profession which in one way or another has let the nation down. That attempt at character assassination of an entire profession has been totally counter-productive if ever its perpetrators thought that such castigation would improve educational standards.
	Everyone desires a general raising of such standards, but lowering the morale of the very people who are meant to achieve that is not clever. In the first instance, you have to build with the bricks you have.
	A concomitant of this tide of denigration, again on the part of successive governments, has been to impose a series of initiatives and changes, some worth while, others pernicious. Either way, cumulatively, these have compounded the stresses and strains felt in schools. Teachers have been subjected to a "double-whammy" reminiscent of practices devised behind the Iron Curtain: Soviet-style Gosplan edicts issued with the rapidity that characterised the "continuous revolution" strategy promulgated by the late Chairman Mao. To these, I should not be surprised to see added, a Napoleonic-type national timetable constructed just to round off the centralisation, indeed the nationalisation, of the entire school system.
	It is all part and parcel of a cast of mind that has determined education policy at all levels, primary, secondary and tertiary, for far too long. This is well illustrated by remarks made by the Secretary of State following the announcement on 20th October 1998 of the creation of a head teachers' staff college. He actually said that his department,
	"saw itself as the equivalent of regional group management with head teachers as its plant managers".
	The language employed is very revealing.
	The cumulative effect of this unbridled innovativeness can be criticised on its own managerialist terms: the endless series of reforms and edicts that has all but overwhelmed the teaching profession was never properly project managed. No one ever stood back to question whether the school system could absorb the plethora of changes and cope with the rate of change to which it was being subjected. As the famous economist, Joseph Schumpter, once aptly observed, governments,
	"always plan too much and always think too little".
	The result to date reveals a demoralised profession, as other noble Lords have attested. Recruitment remains low. There are currently 500 vacancies in London alone and only last week an employment agency has been contracted to bring teachers from Wales to London on a daily basis. It gives a new meaning to the term "bussing" in the lexicon of education. Staff retention is problematic; headships are proving difficult to fill and the plastic and performing arts and team sports are being crowded out of the curriculum. The continuous barrage of reformism has nurtured within teaching--to coin a phrase--a culture of institutionalised fatigue.
	My two specific points concern reforms which, in one case have had, and in the other will have, deleterious consequences. The first is the publication of league tables. They do little for the generality of schools. They are of use only to those parents who can afford to move to what, by the criteria used to compile the tables, are "good" catchment areas. The tables are utterly incapable, for example, of identifying those schools that really add value, serving the most deprived and disadvantaged localities. Struggle as they may, I am convinced that the statisticians in the DfEE will not be able to construct future tables that will be able satisfactorily to accommodate the value-added dimension and give it its due weighting.
	Secondly, I wish to raise my voice along with other noble Lords, as regards the effect of performance-related pay, due to be introduced next September for those at the top of their pay scales. I could accept it for head teachers and others in senior management in our schools, but how on earth will the methodology of assessment be so refined that it can discriminate between, say, a team of teachers preparing pupils for key stage 4? As it is, no less than 200 full-time and 2,000 part-time assessors--a vast army of drones and inspectors, which is one of the growth industries of recent times--are being hurriedly empanelled, together with 30 regional co-ordinators (echoes of Gosplan) at salaries worth £40,000 per annum. Large consultancy fees are being paid to consultants for this exercise in futility--money which could be spent more effectively in our schools. It is high time teachers were allowed to regain their sense of being a profession in the fullest meaning of the definition.

Lord Puttnam: My Lords, I greatly echo the thanks of the House to the noble Baroness, Lady Perry, for making this evening's debate possible. She has given us something to live up to. I also congratulate the right reverend Prelate on his outstanding maiden speech.
	I must begin by declaring several interests. I am chairman of the General Teaching Council, a member of the Government's Education Standards Task Force and chairman of the Teaching Awards Trust. Far more important than any of this is that, in common, I am sure, with most if not all of your Lordships, I declare an obsessive interest in the creation of a successful social and economic future for this country and an absolute conviction that the future rests to a quite extraordinary degree on the shoulders of a gifted and committed generation of schoolteachers. We need teachers with the ability to inform, to inspire and to illuminate. In short, we need teachers with the passion to pass on to every young person in their care an interest in, and a love of, learning sufficient to sustain them through the rest of their lives.
	Looking ahead, the future of classroom practice will almost certainly be dramatically different for teachers and students alike. The changes will feel all the more dramatic given the relative lack of recent development in the methodology of teaching. A doctor from 1900, transported in a time machine to the year 2000, would have absolutely no chance of playing any active role whatsoever in a serious operation. The operating theatre itself would be an entirely alien environment--almost something of a space fantasy. But contrast that with a teacher from 1900. The children may look a little different, but give our teacher a piece of chalk, stand her in front of 30 faces and 30 desks, and she could deliver in most subjects what would be entirely recognisable as a lesson. The change that she would experience goes way beyond the mastery of any "technological" toolbox. The responsibilities of teachers are evolving to meet the changing needs of society.
	In many inner-city environments, schools represent a sanctuary, a refuge even, for any number of children--those who, whether because of poverty or domestic discord, feel isolated from their own families. For many children, school is starting to feel more like home than home itself.
	The Government have sensibly identified a new set of needs for a generation of young people who have no access to the traditional learning environment of the family. Now teachers must fill these social gaps by incorporating the fundamentals of citizenship and teaching basic responsibility for health. In doing so they are expected to supervise their pupils for ever longer hours before and after the traditional school day.
	A fairly recent survey compared the greatest concerns of teachers in 1940 with those of their counterparts in 1990. The results are startling: those of the 1940s included running in the corridors, eating sweets and talking out of turn, whereas the concerns of the 1990s are something quite different. They include assault, rape, robbery, suicide, pregnancy, alcohol and drug abuse.
	In the past 30 years the divorce rate has more than doubled and teenage suicide has increased by almost 300 per cent. In the US the number one health problem for women is now domestic violence. A quarter of all adolescents contract a sexually transmitted disease before they graduate from high school. We have here in Britain developed an impeccable record of mirroring the very least attractive social developments in the United States.
	The time has come to acknowledge, with respect and gratitude, the changing social function of our teachers. In a variety of ways those responsible for preparing young people to meet the growing challenges of adulthood must undoubtedly become, if not the masters, then at the very least, the increasingly expert managers of change.
	It has been estimated that by the year 2005, we shall need 150,000 additional teachers, presenting us with a very considerable recruitment challenge. I say "additional" because that allows for wastage and retirement from the existing workforce. It is to be hoped that the new pay scales for teachers, outlined in last year's Green Paper, are just the beginning of a radical rethink of the reward system of this, the most important of all our professions. However, there are other, more subtle and reflective facets to the recruitment issue than the straightforwardly financial.
	Any definition of a "good education" must surely include confidence. Yet, the very people we look to as a source of confidence are also the profession which we as a society have tended to undermine more systematically than any other. If we are not criticising the recruitment of teachers, we are sneering at the quality of teachers. Our media seem also embarrassed to celebrate the hundreds of thousands of truly remarkable success stories, preferring instead the snappy headline that sensationalises a minuscule number of failures. For example, during the difficult period of 1996-97 when the Ridings School in Yorkshire was placed under special measures, over 300 articles appeared in the national press, blasting out the unequivocal message that we were facing the end of education as we know it.
	However, thanks to Herculean efforts by a new head, she and her team have turned the school around. But, with good news out of fashion, that "mini-miracle" warranted just seven mentions in the national press two years later. Fortunately, the Government at least took notice, and I for one was delighted to see the efforts of the school recognised in this New Year's Honours List.
	As I get older, I am inclined to agree with H L Mencken's view that for every complex problem, there is a simple answer--and it is usually wrong! There can be few problems as complex or as enduring as that presented by our education system. In 1908 approximately 16,000 new teachers were wanted but only 9,000 could be recruited. In 1944 the McNair report on the supply, recruitment and training of teachers concluded that:
	"We are convinced that nothing but drastic reforms involving the expenditure of considerable additional sums of public money will secure what the schools need and what children and young people everywhere deserve".
	Therefore, the problem and the overarching solution have not shifted dramatically.
	However, I draw one development to the attention of your Lordships. That is the establishment of, and the potential that may be offered by, the new general teaching council, which will become fully operational in September next year. I offer the following remarks by way of an invitation to your Lordships or to the Minister for any ideas, advice or even warnings. I see from the Clock that I shall need to ask for your Lordships' indulgence for a short while.
	As I see it, the GTC has a role in meeting the challenges which face the teaching profession in at least three distinct ways. First, in comprising a majority of teachers, the council will set a benchmark of quality across the whole profession. Through the register of qualified professionals, a code of practice and advice on entry and subsequent career development, teachers will at last have a unified public voice, defined by knowledge, expertise and experience.
	Secondly, many, if not most, of this Government's initiatives seek to raise standards by identifying and spreading excellent practice--that which has been tried and tested and shown to work in the classroom. The GTC must ensure that it establishes itself as a respected, creative and constructive voice that will, in the future, be instrumental in the very architecture of change and in decisions relating to the continuing professional development of every single teacher. As a result of that involvement and like any other profession, teachers should develop ownership of the mechanisms through which they are expected to raise the standards of achievement.
	Thirdly, the GTC must prove itself an apolitical advocate for the representation of teachers as they truly are: expert and even, frequently, gifted professionals. The issues of morale and status must be a real priority. With a vastly improved and justifiable stature, a public voice and ever-improving standards for entry, I believe that many of the necessary ingredients exist for raising the public perception of this remarkable profession. The GTC must help to build the trust of the public by celebrating the best, publicising the good, and dealing swiftly, unequivocally and demonstrably with any breaches of that trust. Unfortunately, other key components, such as pay, fall well beyond the remit of the GTC. Here, we can but look to our colleagues in Her Majesty's Treasury for inspiration.
	In closing, I sum up my contribution to the debate by reminding your Lordships that teachers, and only teachers, provide the foundations on which this nation's prosperity rests. That prosperity can then deliver us the well staffed, well resourced health service that we all want, and the humane, dignified and sustainable social security system that we all deserve. I should be interested to hear whether any of your Lordships present this evening can offer any formula for the future of a successful Britain that is not in every single respect built upon a generation of highly trained, highly skilled and brilliantly motivated teachers. I know it to be the determination of this Government to work with the teaching profession to achieve an education system for this country of which we can all be proud.

The Lord Bishop of Blackburn: My Lords, I, too, should like to thank the noble Baroness, Lady Perry of Southwark, for introducing this timely debate. I congratulate my brother Prelate the Lord Bishop of St Albans on giving what I knew would be and, indeed, proved to be an outstanding maiden speech. I welcome the foundation and the establishment of the GTC and, indeed, the noble Lord, Lord Puttnam, as its first chairman.
	As a former teacher who is now privileged to visit schools right across the educational spectrum--indeed, I began this day with numeracy hour in a school in a part of the world which will be well known to the noble Baroness, Lady Massey of Darwen--I see at first hand the teachers' dedication, the enthusiasm for their task, their sheer professionalism, creative imagination and pastoral care for their pupils.
	I believe it is sad that the quality of their work is often obscured by the attention drawn to the minority of teachers who, as in other professions, underperform. Standards are rising despite the pressures on our teachers. Those pressures in part stem from the fact that we have too few teachers. Therefore, last October I was delighted to share with people from the DEE, the TTA and many others in a day conference on the vocation to teach, hosted at Lambeth Palace by the most reverend Primate the Archbishop of Canterbury.
	In my own diocese of Blackburn, where education is a high priority, I decided to mark the new millennium by launching a specific appeal for people to consider whether they had a vocation to teach. As chairman of the Church of England Board of Education, I am sure that the recruitment and training of teachers will feature in the major review of Church of England schools which is to be chaired by the noble Lord, Lord Dearing, to whom we owe an immense debt of gratitude for all that he has done to improve our educational provision in this country.
	However, there are real pressures on teachers which prevent them giving of their best and being "that loving authority", as I heard their role described recently at a seminar in Cape Town--one which gives the pupil a sense of security and cares for both the pupils and the subject they teach. Some might question whether, in reality, the present pressures on teachers are any greater than those on doctors, lawyers, the clergy or managers in industry and commerce. "Too much paper" is a constant refrain in school staff rooms. There is too much accountability in the form of returns to be completed. Those things can sap even the best teachers' enthusiasm for their work. T S Eliot asked:
	"Where is the wisdom we have lost in knowledge?
	Where is the knowledge we have lost in information?" Do we want our teachers to educate and to bring out the best in their pupils, or do we want some lesser, if important, purpose; namely, for them to train our youngsters to earn a living?
	However, I detect, as have other noble Lords, some significant pressures on the staff in our schools. The first has gone on for years under both administrations. Through a proper desire to obtain the best for the youngsters and for society, new ideas have been thrust upon the schools. I suspect that few of them have been allowed to be tried for a generation to see what the outcome might be before the next educational panacea to our ills has been introduced. I favour the national curriculum. But I know how many things have been introduced without our teachers being given the necessary time from their ongoing work to assimilate change and to adjust to what is required. The result is that fatigue creeps in. Since, unlike the Palace of Westminster, there are no hiding places in a classroom, even good teachers can become jaded. The management of change requires additional time, money and resources. If we are honest, those have often been lacking.
	Secondly, it is entirely proper that parents, taxpayers and others know how things are going in our schools, and that weak and ineffective staff are weeded out. We do not want them. Ofsted has much to commend it. However, like the rest of us, the inspectors are not always right. Some do not have much clue about the pressures in particular areas in which the schools are situated. Some seem more interested in the number of policy statements that a school can collect than in pastoral care of the pupils. Some do not listen. There is evidence to suggest that they come with their own specific agenda.
	My question to the Minister is whether all that needs to be quite so public. There are newspaper articles in local papers which target individuals who have little opportunity to reply. That is set alongside league tables which fail to show the value-added achievement of schools in Blackburn, Preston and inner cities where for many of the pupils English is not their first language. Such matters put unnecessary pressures on some of our best head teachers and their staff.
	The clergy tell me that they spend a good deal of time pre-Ofsted and post-Ofsted giving pastoral help to teachers who feel less than valued by the process.
	The third area of pressure on teachers is much more difficult to describe and, I suspect, address. The noble Lord, Lord Puttnam, referred to it. It can be summed up in two words--over-expectation. Sadly, there are many problems in society and most of them find their way, through the children, into the classroom. Pupils experience poverty, violence, child abuse, racism, family breakdown, and so on. But to that must be added the tendency to believe that if parents, the law, the Church and faith communities and the Government cannot solve those problems and create that decent society which we all desire, then the schools will do so.
	In that way, citizenship is added to the curriculum. It seems that training for parenthood is to be next. There is a list of good ideas which is almost endless. But it is not reasonable to expect teachers to deal with those matters in a society in which, despite the valiant efforts of people like Dr Nick Tate, the QCA, the Churches and others, there is no generally accepted moral and spiritual framework of values. That is a great change from when I was in the classroom. Teachers are expected to make up for the deficiencies which others detect in the upbringing of the young but without an agreed moral framework within which to do that, let alone compete with the pressures of home, the television, peer groups, and so on.
	An increasing number of parents turn to church schools to provide what they require. On the other hand, I know that in these days of political correctness, it can be tough for Christian teachers and pupils to be open about their faith in some community schools. Nevertheless, teachers of all subjects do and must realise that their words and example influence the lives of impressionable children and young people and, as such, they bear an awesome responsibility for the future.
	I speak as chair of the governor of St Martins, Lancaster, which is one of the largest providers of ITT. I hope that during initial teacher training, the help will be given, which is desperately needed at the present time. I hope that on Inset days, those problems will be addressed.
	Teachers must be women and men of hope whose values and commitment to service will inspire others and help to create a caring society. Teaching must be a vocation and not simply a job of work to be done.

Lord Dormand of Easington: My Lords, in my early days as a chief officer, we had no sophisticated method for the payment of teachers like sending a cheque by post or putting a payment directly into their bank accounts. It was much more simple than that. The head teacher of the school was sent a cheque which would cover the salaries of all the teachers in the school at that time. The head teacher would pop down to the local Co-op--this was in the north-east, of course--cash the cheque and then put the money into envelopes. The head teacher would then trot round and put the envelope on the teacher's desk. On one occasion, there was a six year-old who was watching what was going on with great curiosity. He said to the teacher at the desk, "What is that?" The teacher said, "It is my pay". The little six year-old, with even more curiosity, said, "Oh, where do you work?" That demonstrates a number of things. But the child obviously thought that it was a great pleasure and joy for the teacher to come to school and have the privilege of teaching him.
	Most people accept the importance of teachers. But the real question is: what can be done to improve, and improve substantially, the status and importance of teachers in society and particularly in the view of parents. The fact that there is a continuing shortage of teachers, particularly in some specialist areas and in some secondary schools, is a clear indication that teaching does not appeal to many younger people.
	The Government have made strenuous efforts to improve the situation and to recruit more teachers. The recent campaign which had the theme that no one forgets a good teacher was excellent. I praise the Government for that. There has been an increase in recruitment since that campaign started. But much remains to be done.
	Two major steps have been taken in recent years to enhance the status of teachers. First, making teaching a graduate profession was of great importance. For a long time the emphasis was on training rather than on education. Effective training was and is of crucial importance. But society must see teaching as requiring high academic standards. In my view, that has not necessarily been the case in the past.
	The degrees of B.Ed and M.Ed and the postgraduate Diploma in Education are not yet, I fear, firmly established in the minds of people concerned about education. But I am optimistic about the future.
	Secondly, establishing general teaching councils in England and Wales is an achievement which some of us have advocated for many years. I am delighted that the present Government recognised the importance of the councils so quickly and had the provision placed on the statute book so soon. The councils are independent of government and will reflect the views of teachers. They will provide advice to governments on initial teacher education, induction and the professional enrolment of teachers. They will be responsible for registering all qualified teachers. Registration will be a requirement for employment as a teacher in maintained schools in England and Wales.
	The GTCs will have powers to discipline or deregister teachers on the grounds of professional misconduct or serious incompetence. As a former chief officer, I can say that that is of great value.
	It is crucial that personal conduct and behaviour should be a measure of that importance, not least because teachers are dealing with young people. Misconduct by teachers tends to receive a great deal of publicity, much more than, for example, solicitors and doctors, although the medical profession has received its fair share of adverse publicity in recent months.
	I mention that because it is a self-discipline to which teachers are subjected and they are remarkably successful considering the thousands of them doing a very difficult job day in, day out.
	There is another practical way in which the importance of teachers can be recognised; that is, by the greater employment of teachers' assistants. Much of their work, although not all, is of a physical nature, usually, although not always, carried out before and after lessons. It is work which should not be done by teachers simply because it takes time away from the professional duties of the teacher. I hope that my noble friend understands--and I am sure she does--how much teachers appreciate such assistance. I was heartened by the recent announcement by the Minister in another place that there is to be not only a major increase in the number of teachers' assistants but--and this is of equal importance--also that they will receive appropriate training for the work.
	I repeat, but not in detail, what has been said by noble Lords about the number of forms, returns, questionnaires and so on to be completed. When talking to teachers, one finds that they all make the same complaint. I hope that the Government will recognise that and do something about it. The work, professionalism and time of teachers is far too important to have it curtailed by such time-consuming matters which are not directly related to teaching.
	The importance of teachers is self-evident. It has been repeated many times in the debate so far. It is self-evident to many of us. But it is the duty of society, through Parliament, through local authorities and universities and colleges to ensure that their value is maximised. That will require continuing examination of their work and how it is done. That should be done not in a critical sense but in a positive and constructive way and done with full consultation with teachers.

Baroness Trumpington: My Lords, I believe passionately in the importance of teachers. I am most certainly not a teacher, although I was married to a distinguished one for over 30 years.
	However, when the French master in my husband's school was ill, I was given the opportunity to teach a class of boys who would never make French scholars. I began with the novel that they had already started reading about two characters, Georges et Cecille. Of course, my pupils took the mickey out of me, insisting that George kissed Cecil.
	A change was indicated. I thought that it would be useful for the boys to translate articles from French newspapers. That ploy did not last long, owing to the undesirable articles that they chose to translate!
	Finally, I struck gold. I remembered that my brother had once told me that he had turned to his dinner date remarking that he hated sweetbreads and promptly ordered riz de veaux, so I thought that the most useful thing I could teach those boys was how to read a French menu. That was a great success and the term ended with the entire class and myself cooking the most outrageous lunch in my kitchen. The guest of honour was my husband. The campus was denuded of flowers for the table and an impeccable menu was put in front of every participant.
	A postscript to that experience is that I had overlooked the fact that I would have to write something in each boys' report. To this day, I hope that some of those 15 boys are grateful to me for writing:
	"This boy should be sent to Paris to find out what life is all about"!
	Seriously, what I have described certainly taught me a little about the patience, humour and tenacity needed to be a teacher. Over and over again I have heard people pay tribute to a particular teacher whose special efforts provoked their curiosity and sparked off the interest and love of a subject which have remained with them throughout their lives.
	That influence or encouragement can be started at the beginning of schooling. The primary school teacher who senses when a child has difficulties and who puts in that extra effort and commitment is as important as the sixth-form teacher or indeed the university tutor.
	These days one becomes outdated so quickly that I hesitate to mention that in the past I was a governor of two secondary modern schools in Cambridge as well as a school that was then known as an approved school. Far too often people forget the amount of extracurricular activities undertaken by teachers and they are unaware of the extra work involved in adapting to frequent government changes to the curriculum.
	Often people ignore the physical dangers that teachers may face in poorer parts of the country. Bullying does not occur only on a pupil-to-pupil basis. On occasion, children may try things on with a young and inexperienced teacher. What the Army used to call "dumb insolence" is indeed one of the most difficult aspects of life that a teacher must overcome.
	My husband was headmaster of the Leys School in Cambridge for 17 happy years, where it was not always easy for the teachers to teach the rather moderate sons of Nobel prize winners who had great aspirations for them. Incidentally, that school was the inspiration for the book Goodbye Mr Chips, written by an old boy. Several Members of this House and the other place were pupils of my husband. Indeed, he always said that Douglas Hurd was his brainiest pupil.
	Married life in three different boys' schools, in one as an assistant master's wife and in two as the wife of the headmaster, gave me ample opportunity to observe teachers and in most cases to admire their dedication and mastery of their subjects. As a profession, teachers are far too often underrated. Surely, it is right to change an old saying: behind every great man is a great teacher.

Baroness Linklater of Butterstone: My Lords, I am most grateful to the noble Baroness, Lady Perry, for calling our attention to this most crucial subject. I congratulate the right reverend Prelate on a marvellous maiden speech.
	Nothing is more important than the lives and future prospects of our children, and their experiences of the teachers that they encounter on the way is pivotal. Albert Einstein said:
	"It is the supreme art of the teacher to awaken joy in creative expression and knowledge".
	I hope that we have all known one or two who have opened our eyes and influenced our lives for the better.
	I shall never forget Miss Menzies in my first, one-teacher school in Butterstone village who was a much loved, much respected and well remembered figure in the community. I have also seen children whose teachers have unwittingly failed to understand their difficulties or meet their particular needs. That is the experience of the "educationally fragile" children when they come to the school that I founded in Perthshire.
	That school is also a graphic example of the potential that good teachers have to transform the lives and prospects of children for whom, in our case, life had hitherto been nothing but a struggle. In a learning environment that suits them and with teaching that suits their learning styles, they discover that they are capable of more than they ever dreamed of. This year our first pupil went to university. Through the teachers at the school, joy in creative expression and knowledge is a reality.
	I want to concentrate on the issue of the professional development of teachers and of head teachers in particular. It is, of course, vitally important in the careers of all teachers, but if anything this is particularly true for head teachers whose role and influence is so critical in any establishment, whatever its size.
	If head teachers are to grow and develop, if they are to be in a position to keep up with the demands of society both globally and locally, if they are simply to be able to top up their skills, knowledge and awareness, and if they are to develop into that relatively rare animal the "reflective practitioner", the regular provision of professional development is essential.
	It seems extraordinary that only in the past few years has the availability of any training in a national or coherent way become established. The national professional qualification for headship followed by headlamp is now available for aspiring heads and those on their first appointment, but the leadership programme for serving heads is only one year-old and not available to every head teacher. The fact that the Education Secretary has said that the qualification for aspiring heads will become mandatory by 2002, and that there are plans to have a national college for school leadership by the autumn is greatly welcomed.
	The same process is taking place in Scotland, where we have had a GTC for some time. Indeed the Standards in Scotland's Schools etc. Bill was laid before the Scottish Parliament on Thursday. The national qualification for headship is only just coming on stream for aspiring heads--it is also likely to become mandatory--and a development programme for serving heads is still at the concept stage. In Scotland, ideas have not yet gelled on what form a national staff college may take.
	Professor John Tomlinson's definitive contribution to the debate on inclusive learning revolves around achieving a better understanding of the differing learning styles of people of all ages and abilities, and also the importance of creating the most appropriate educational environment for individuals to achieve the most effective outcomes. I believe that not only does his thinking apply to all learners, but it can also be usefully applied to teachers and their development. One parallels the other.
	If we are to maximise the uses of head teacher training, provision must take account of the individual needs of heads, including their strengths and weaknesses, in the multi-layered role that they have to play. After all, they are required not only to be educators and managers, but also businessmen and women, PR people, fund raisers and above all leaders. Those skills have to be deployed in a vast range of settings from small rural schools to large inner urban comprehensives and specialist schools.
	Therefore, to be meaningful all these factors have to be taken into account if the potential of head teachers is to be maximised. Professional development programmes will have to address the individual needs and circumstances of individual heads. Head teachers' development needs run parallel with those of the children whom they teach, and the environment in which they all teach and learn. Ultimately, the status and respect in which the profession should be held by society will be enhanced by the growth in skills, professionalism and quality of teachers, thus providing more opportunity for the Miss Menzies of this world to shine through.
	I have been involved in the creative writing prize in Scotland called the Pushkin Prizes. Each year the Russian children we meet speak openly and easily about the respect they have for their teachers and how much they value their school--not a common experience in this country. I am also a trustee of the Esmee Fairbairn Trust which made available £750,000 in 1999-2000 for projects designed to promote the professional development of head teachers, for which bids came in from throughout the country. The final 12 projects selected, of remarkable range and quality involving 215 schools, demonstrated the value placed on such an opportunity for quality reflection and development time with fellow professionals. I hope that the outcomes will ultimately help to develop skills as well as the status and respect that our teachers surely deserve.
	Despite all the competing demands and claims on resources, I urge the Government to put added commitment as well as cash into this still terribly undeveloped but hugely productive and important area of teachers' lives.

Earl Baldwin of Bewdley: My Lords, I am grateful for the chance to contribute to this debate from the Cross-Benches after the party speakers have all spoken. I am particularly grateful to the noble Baroness. I was delighted to hear her say so many good things about teachers which I firmly believe myself. I hope she will not take it amiss if I say that calling attention to the importance of teachers is akin to praising motherhood. There are few people who would disagree with the sentiment. Yet for some reason in this country we never seem to accord the profession the support and status that it deserves. We are quick to blame teachers for the ills of society when things go wrong. When things go right, and this country enjoys success of whatever kind, I have never heard our schools praised for their part in it.
	I taught for some years in the secondary sector; first, in a very traditional boys' public school, and then in a small-town comprehensive. On teaching practice, and later as an LEA education officer, I saw something of the problems that teachers face in really difficult areas and my admiration for them knew, and knows, no bounds.
	At the best of times teaching is a demanding job; "desperately hard work" in the words of the noble Baroness, Lady Sharp. I shall never forget the first few days in my first school. For sheer pace I can only compare it to one's introduction to army life: my feet hardly touched the ground for a week. I think there are two things which outsiders do not grasp, even when the workload and commitment are generally accepted. One is that the initiative in the classroom lies with the teacher the whole time. There is no let-up. It is as if one spent one's working day chairing a succession of meetings with people many of whom would much rather not be there. The toll in nervous energy can be extreme, as has been shown in objective medical tests of stress taken in the school holidays--those holidays that are often criticised for their length but are barely sufficient for recharging batteries and catching up on one's own affairs.
	The second factor is that the teachers run their schools. There is no separate cadre of administrators to attend to health and safety, order the necessary teaching aids, set up parents' evenings and so on. The teaching staff do it all, on top of their classroom work. Secretarial support is virtually non-existent. As for the costs of such work, I well remember a local business friend saying to a head teacher in my presence, "You'll put that down to expenses, of course?", and the cultural shock this produced in a milieu where there is little money for basics, let alone expenses, and teachers stand much of the cost of materials and car mileage out of their own pockets, as they always have done.
	So why is all this not generally recognised? Well, sometimes it is, but for some time now, as has been said, we have been in a climate of blame where the pendulum has swung, as pendulums do, towards one end of the educational spectrum. The seeds were sown of course when it was at the other end, back in the 1960s and 1970s. I believe this period has not received its due. I was trained as a teacher in those times and, in contrast to what the noble Lord, Lord Pilkington, said, they were not all bad. There was a liveliness, a questioning, an enthusiasm in the profession which did not sell our children quite as short as is now claimed. Above all, there was a reaction to a certain dry, fact- and memory-based approach to learning which I believe was overdue. I have taught in both modes, and I can assure your Lordships that it is a great deal easier to sit your class down and tell them to open their Whitmarsh at page 51 and work through the first four exercises than it is to produce something imaginative which will make them want to become lifelong learners as opposed to passing their GCSE with a minimum grade.
	Teachers then were trying to do something more difficult than their predecessors had done, and they deserve recognition for it. It went too far, as pendulums do. There is no question of that. As a linguist I had an uphill battle persuading some pupils that you had to learn lists of vocabulary if you were going to get anywhere with the subject. But the good that came out of those times should not be overlooked, however unfashionable it may appear in a different climate.
	The reaction to the '60s and '70s has been compounded by perceptions of falling standards. As someone whose interests have recently moved towards healthcare, which aims to be research-based, I am often appalled by the poor quality of evidence for so much that is claimed about schools. This is not a criticism of educational researchers, but of the readiness of opinion-formers and policy-makers to draw sweeping conclusions from the slenderest of bases.
	I simply do not believe that the situation in schools has been as dire as it is often painted, nor that teachers deserve the opprobrium that is heaped upon them. One of the worst offenders, I am sorry to say, has been The Times, which for years has run a relentless crusade against the maintained sector, characterised by an absence of sound evidence, frequent misunderstanding of the issues, and a technique of highlighting failures while leaving to the small print, if at all, any mention of success. The constant repetition of this kind of thing has had its effect--the noble Lord, Lord Puttnam, made something of this point--on public opinion as well as on teacher morale.
	We have had two decades now of radical change, with a tidal wave of legislation (in some of which I have been involved in your Lordships' House) which has kept the ground constantly moving under teachers' feet, accompanied by a rise in form-filling and general paperwork in schools which has been unprecedented. I am no more claiming that all reforms, in their conception at any rate, have been bad (for example, the GTC) than I would claim that everything a generation ago was good. But the whole thing has been overblown. The pendulum has swung too far, and against a background of declining family values teachers are under greater pressure than they have ever been. That is not ultimately good for our children.
	It is not surprising that many schools cannot get the staff they need. There will not be a supply of teachers unless the profession is seen as a desirable place to be. It will not be so seen unless pay, working conditions and general resourcing are acceptable; unless a period of stability is introduced, with future change the subject of thorough consultation; unless, as the noble Baroness emphasised, teachers' creativity is encouraged; and, above all, unless teachers are given full credit for the good and difficult things that they do, and the habit of destructive criticism is reined in. This is the best way we can call attention to the importance of teachers.

Lord Tope: My Lords, I begin by thanking the noble Baroness, Lady Perry, not just for initiating this debate; not even for what was an excellent opening speech, with every word of which I agreed (which is rare with speakers on the Benches on which she sits, but she summarised the position exceptionally well); but also for giving us a debate where every single speech has been excellent and to the point, at least so far. We heard an excellent maiden speech from the right reverend Prelate the Bishop of St Albans, and also from his colleague whose speeches on this subject I always enjoy.
	I must start by declaring some interests and non-interests. I have frequently said in these debates that I am married to a teacher. I do not believe I have before confessed that I met her in her second year at teacher training college; I lived through teacher training. I have lived through every change, good and bad, in the teaching profession in schools for the past 27 years, so I have a little idea of the effects of those changes.
	I have a rather sad non-interest in that my 25 year-old son graduated with a first-class degree last summer and a place at teacher training college. He chose not to take it up. I have had discussions with him and his friends about why and, sadly, in that we have so much in common.
	I have never stood to teach in a classroom in my life. In that I am uncommon in this debate. It struck me that most of the people speaking in this debate at least have personal experience of what it is like to be at what in this House we probably still call the "chalk face"--I suspect a rather old-fashioned term. I have never done that, but for most of the past 25 years I have been a school governor and for the last five or six years I have been a governor of a fairly small junior school in the ward I represent on the council--a council on which I served as leader for 13 years. It is of course a local education authority. So I have enough experience to know and to have a strong view about the role of a politician in education and the role of a teacher in education.
	We spend a large sum of money, though not enough, on training teachers to be professionals, and we need to treat them as professionals. It is not my job as a politician who has not been trained as a professional teacher to tell teachers how to teach or even what to teach. My job, and the job of all of us in our political roles, is to provide the resources, the framework and above all the climate in which teachers can be enabled to do the job for which they have been trained.
	That is the root of what has been coming through from speaker after speaker in this debate. It is about climate. There is a common view in this country that morale in the teaching profession is low. We have been saying that it is at rock bottom for as long as I can remember, and it is undoubtedly low. Many teachers are exhausted and many of them of my age and generation are longing for retirement. Indeed, not so long ago the Government had to take measures to tackle the problems caused by so many teachers taking early retirement.
	We know about the difficulties in recruitment and we know about the efforts of the Government and of the Teacher Training Agency to try to tackle recruitment problems. In some geographical areas and in some subject areas we know there is certainly a crisis. The measures which have been taken to combat that, while bringing some improvements, have certainly not solved the crisis. If it is a problem now, it is going to be an even greater problem in 10 or 15 years' time when teachers coming into the profession now are taking up senior positions. So my concern is not just for now but for the problem that will have to be faced in our schools in 10 or 15 years' time.
	I am based in London and I know that the problem is particularly acute there. We are concerned not only about the quality of teachers, but one difficulty is that teachers simply cannot afford to live in London and the south east of England. They have a different quality of life in other parts of the country. Why on earth a young person should wish to come to teach in a London school, with all the stresses and strains of the job and also those of trying to pay for even basic accommodation in London, I simply do not know.
	Other problems on which there is a common view today include initiative overload. We have initiatives, initiatives, initiatives. Some of them are very good: I acknowledge that. Some are indifferent and some, I would say, are bad. In one sense that almost does not matter because there are just too many initiatives. That is the point. Perhaps I could say in parenthesis that letters from the Secretary of State sent to each school telling them how much extra money they are going to get do not help. They are at best grossly misleading and simply set the school against the education authority, the education authority against the Government, and so on, in a vicious spiral.
	There has been too much measuring and testing. The justification for testing--and none of us is against it as such--must surely be to improve the child's education and not to provide information for a government to use, and sometimes to misuse. Much has been said about league tables. They too are misleading. I come from an education authority which, mostly because of our geographical situation but also because of the quality of teaching, is almost always at the top of the league tables. It is wonderful to be at the top and of course I would rather be there than at the bottom, but those league tables are misleading. If we are going to have them at all--and I would much rather we did not--we need to concentrate on finding effective tables that measure added value. Then my local education authority would have a much harder job getting to the top of the table. Of course I hope it will and I shall do my best to help it to get there.
	Performance-related pay has also been talked about. I worry about that. As an idea, I am not strongly against it: it is not unknown in many other professions and occupations. However, I have come to worry more and more about the way in which it will be implemented. It is a question of the practical effect. As it happens, on Sunday evening at home my wife and I were talking about the effect that she thinks PRP could have within her small infants school. I suspect that it will take the decision--it has not done so yet--that my noble friend's school has taken: that it will not go for PRP simply because it will be so divisive and destructive to the team which is necessary to run a small school.
	We have during the debate perhaps been a little long on the problems and a little short on the solutions: 'twas ever so, and I do not suggest there is any quick fix. This problem has not come about in just the past few years, so certainly I cannot talk about any quick fix. However, I suggest that the most popular initiative the Government could take would be to declare an initiative-free period. If they were to announce tonight--and I offer this to the Minister--that there will be no more new initiatives for perhaps 12 months, I guarantee the Minister instant popularity with the teaching profession.
	We need to change the climate; we need to concentrate on raising and praising, not naming and shaming. There is nothing more undermining to teachers than to talk about bad teachers. Yes, there are bad teachers, but they are a tiny minority and the people who feel most strongly about bad teachers are other teachers. We need praising and raising. Let us stop undermining. We need to encourage creativity. The national curriculum is here to stay, I acknowledge that; but it needs to be a lot more flexible and a lot less prescriptive. We need to encourage the creativity that others have talked about.
	The General Teaching Council we have discussed here many times over many years has a most important role to play. I am delighted that the noble Lord, Lord Puttnam, is to be its first chair. I wish him and his colleagues every success. It is vital for it to succeed and for us to demonstrate that we are treating teachers as professionals.
	On recruitment, if we are to attract bright young graduates--and I have to say that not all graduates going into teaching are those with the highest qualifications--into post-graduate teaching we have to grasp the nettle. I acknowledge it is rather an expensive nettle but we ought to pay them an actual training salary. Other professions do it. The police do it and it is common in industry. If we really value teachers then we need to show that at the beginning and be prepared to pay the students a training salary. We must tackle the problem of relocation expenses. Perhaps I may ask the Minister in conclusion whether it would be possible to allow relocation expenses to be payable from the standards funds.
	This has been a useful and important debate. If it becomes known to the teaching profession, which I fear it may not, it would do something to increase morale. The title of the debate refers to the importance of teachers and, to quote the noble Baroness who introduced it, now is the time to turn our fine words into fine deeds. I believe that all of us in public life have a role to play in that. It is not just a job for the Government: it is a job for all of us in public life.

Baroness Blatch: My Lords, I, too, welcome the debate that we are having this evening. It has been excellent and was opened with an equally excellent speech from my noble friend Lady Perry, who speaks with wisdom and great authority. Indeed, she has devoted all her working life to date to education. I welcome my noble friends Lady Trumpington and Lord Pilkington who, again, also speak with knowledge and experience, albeit with teaching young boys French in a novel way.
	Almost every one who has spoken so far has done so from direct experience. But it is confessional time. Like the noble Lord, Lord Tope, the only direct teaching experience that I can claim, apart from having been something of a teacher to my children, is as a Sunday school teacher. I have voluntarily helped in schools and have been chairman of a playgroup and toddlers' group for many years. However, apart from that, my experience does not match that of many other noble Lords.
	This is an important debate not least because, as so many have acknowledged, teachers are central to education. They are central to the lives of all our children and teaching is a noble profession. There is something awesome about the responsibility for liberating, developing and nurturing the skills and talents of young people.
	My noble friend Lady Perry rightly focused on the professional nature of teaching and on the importance of giving teachers their professional freedom. I hope that the noble Lord, Lord Puttnam, for whom I have the greatest admiration and whom I know to be passionate about teachers and teaching, will take up this issue and cast a critical eye over the creeping central control over every aspect of teachers and teaching.
	There are many issues that impact on the lives of teachers and their teaching which need addressing. I have in mind funding, pay and conditions, professional autonomy, quality, recruitment and much more. I make no apology for raising the issue of funding first because expectations of teachers in May 1997 were very high, and now there is some anxiety. Staffing is well known to be the largest head of expenditure. Therefore schools are concerned about the level of that core funding for the every-day running of their schools.
	As a percentage of GDP, spending on education has in fact gone down. From 1992-93 to 1996-97 it was 5 per cent of GDP; it has now fallen to 4.7 per cent. Expenditure that would be needed to match spending as a percentage of GDP between 1992 and 1997 at today's prices would be £222.6 billion. The Government's actual and planned spending between 1997 and 2002 is £209 billion, leaving a real shortfall of £12.8 billion. These are official figures from the House of Commons Library, based on the Treasury's own statistics.
	More and more staff, governors and parents are realising that the public presentation of the £19 billion allocation to education over three years was not only grossly exaggerated; it was also triple counted. The allocation in each of the three years was just over £3 billion. As I said, it does not add up to the percentage of GDP provided for education during the last five years of the previous Conservative Parliament.
	It is certainly true that the day-to-day core funding for schools has been disproportionately affected by the money that is now held back by the Department for Education and Employment. The volume of moneys "top-sliced" annually by the department has grown to an all-time record. Whether local education authorities or schools receive any of these resources is something of a lottery and the raft of administration required to process the allocation under the various schemes is also costly. If we add to this the mountain of bureaucracy that was created within schools and LEAs by the Government in the 1998 education Act, we can see that it is very costly and time consuming.
	No fewer than 13 statutory plans have to be prepared, negotiated and consulted upon, sent to the Department for Education and Employment for approval and then reviewed and updated annually. All this has put incredible burdens upon hard-pressed professional staff, including head teachers and their staff. Only this week a head teacher brought to my notice an incredible tome of guidelines to schools on exclusions; and there were shelves of other such weighty documents.
	The introduction of a very bureaucratic system of performance related pay--it has already been referred to--appears to have stumbled. I understand that next year's pay award is likely to be announced any day now. In fact, the fairies at the bottom of my garden tell me that it may even be tomorrow. However, I have to tell that Minister that unless local education authorities receive considerably more than is planned they will not have the ability to meet any pay increase above the rate of inflation. Given that teachers are expected to receive their performance related pay this September, can the Minister tell us what progress is being made on all the necessary preliminary work as regards assessment? My information is that there is a considerable delay in this work. Will LEAs be reimbursed in full to meet the cost of performance related pay? I totally agree with the noble Lord, Lord Smith of Clifton, who described this as a "cumbersome" system. Like him, I believe that the people best able to judge the proficiency of their schools and of their staff--and operate collegiately if that is their wish--are the head teachers and governors at local level.
	As regards recruitment, can the Minister comment on recent reports of a crisis in London, which, again, has already been mentioned? I have in mind schools that recruited a number of Commonwealth teachers, including some from Australia and New Zealand. I understand that a number of those teachers visited their relative home countries for the millennium holiday and have not returned to London. Can the noble Baroness tell the House how many vacancies there are in London and what the state of recruitment is in our London schools?
	As has been widely reported in the press, there is also a dearth of science and maths teachers. Can the Minister tell us what the position is in this respect? Throughout the country one hears about chemists teaching physics and biology, physicists teaching chemistry and biology and biologists teaching chemistry and physics. This appears to be widespread. Given the importance of science in today's world, can the noble Baroness comment on this mis-match between the teacher's qualification and the subject being taught?
	I understand that there is also to be a change in A-level teaching this September. I know that many teachers have welcomed the thrust of that change and the philosophy behind it. But, again, my understanding is that they have not received the syllabuses. That makes it very difficult and puts enormous pressures on secondary school teachers who have to plan the teaching programmes for the coming two years.
	As my noble friend Lady Perry emphasised, the most worrying aspect of the education reform since 1997 is the degree to which professional autonomy has been lost. One head teacher was quoted as saying, "For all the freedom I now have, I might as well rent deck chairs on the beach". There is now so much prescription, Secretary of State direction, compulsory form filling, mindless bureaucracy and a serious loss of whole-school autonomy. What to teach, how to teach and when to teach is the order of the day. Why is it not possible to exempt those schools that are delivering good teaching and high standards from such detailed prescription? Why not concentrate only on those under-performing schools? During the debate on a recent Starred Question, I commented upon the number of really excellent primary schools and their staff who feel inhibited by the highly-prescriptive literacy strategy. Why not, in conjunction with their Ofsted reports, set them free?
	I turn now to the new initiatives to train an army of teaching assistants and technicians. If they are not to substitute for the teacher--I hope that that is not the case--they will be an additional cost to train and to employ. Can the Minister say how many of them there will be, what will be their cost and who will pay? Further, will the source of funding again be the fast-diminishing £19 billion?
	The Government speak the language of standards and excellence in education. Like my noble friend Lady Perry, I do not doubt the genuine aims of the Secretary of State and his team in the matter. However, the record so far is questionable: the abolition of assisted places, which was an important rung in the ladder for bright young people from low-income families; the abolition of the autonomy of grant maintained schools which is much missed; the curtailment of selection on the grounds of ability; a pernicious war of attrition through a petition and balloting system against our grammar schools--another important lifeline to bright young children from low-income families; the emasculation of the professionalism of our teachers; the introduction of a costly bureaucracy; and the unprecedented central control over a record percentage of the education budget.
	There was also the matter of the delivery of the class size pledge for five, six and seven year-olds. Whatever one may think about that, it was predicted that it would put pressure on our junior schools, and indeed it is doing so. Over the past two years class sizes in nursery, junior and secondary schools have risen and more children are now being shunted around as a direct result of the inflexible nature of the implementation of that pledge.
	I refer to the unfairness of requiring would-be primary teachers studying for Bachelor of Education over four years to pay student fees for the fourth year when graduates who spend a fourth year doing a PGCE have the fee waived. So many initiatives have been announced and have become lost in the ether. I agree with the comments of the noble Lord, Lord Tope, in that regard.
	Schools are already subject to regular inspection and to a transparent system of information to parents and their communities. We would wish to cut through this costly bureaucracy. We would wish to devolve more funding to local level and we would wish to re-introduce more autonomy and flexibility to schools. We would wish to free up the good professional teachers to do best what I described as an awesome challenge; namely, to liberate, to develop and to nurture the skills and talents of young people. It is a noble calling. I know that my noble friend Lady Perry had that in mind when presenting the opportunity for us to discuss the importance of teachers.

Baroness Blackstone: My Lords, I begin by congratulating the right reverend Prelate the Bishop of St Albans on his excellent maiden speech which I thought was delivered with passion and conviction. It demonstrated a great deal of understanding of the teaching profession.
	I am also most grateful to the noble Baroness, Lady Perry, for giving me this opportunity to pay tribute to teachers and to outline what we are doing to strengthen the profession. I confirm that it is our intention to raise the status of teachers. I very much agree with what she said on the importance of creativity in our education system and indeed in our society.
	The importance of teachers is no longer self-evident. The profession started when information was scarce. Famine has now turned to feast and the argument that teachers can be replaced by machines looks increasingly seductive, although it is completely wrong. There are many ways in which information and IT can enrich and accelerate children's learning, but the importance of teachers has never been greater. All of us are only here today because of the inspiration of some teachers who taught us when we were young. I was grateful to hear the noble Baroness, Lady Linklater, and my noble friend Lord Haskel refer to some of the teachers who had inspired them.
	Education is the key to prosperity and social inclusion, both individual and national. That is why this Government are so firmly committed to ensuring that every child realises his or her full learning potential. The classroom is, and will continue to be, the single most important place where learning happens, and teachers are the people who make it happen. At this point I should join with my fellow Front Bench speakers in the "confessional". I have not been a teacher in primary or secondary schools, other than during one brief experience before I went to university when I taught for one term in a boys' prep school. I cannot match in any way the amusing anecdotes of the noble Baroness, Lady Trumpington. However, I became much more popular as a result of instituting a good-night kiss for the eight and nine year-olds when they were put to bed when it was my duty to do so!
	The Government regard the status and quality of the teaching profession as crucial to the future of this country. Therefore strengthening the profession is one of our top priorities. Professions need an independent voice. That is what the General Teaching Council will provide. For years teachers have pressed for such a body and we have now made it a reality. I very much appreciate the welcome that was given to the GTC by my noble friend Lord Dormand of Easington and the noble Baroness, Lady Perry. I am delighted that my noble friend Lord Puttnam will be the first chair of the council. As other speakers have said, he is a dedicated champion of the teaching profession. His outstanding work in establishing a national award scheme for excellent teachers clearly demonstrates that.
	It is certainly true that many teachers are doing an excellent job. Rising standards of achievement by pupils show that clearly. However, the profession has recruitment problems and a career structure which does not properly reward good work in the classroom. The quality of leadership, training, professional development and support is also patchy. The challenge is to make teaching a first-class profession which attracts and gets the best out of the kind of people who make good teachers. That is what our reform programme is all about. It has four interlocking strands designed to improve leadership, rewards, training and support for the profession.
	The first strand seeks to strengthen school leadership. Not much has been said about that in the debate, with the notable exception of the noble Baroness, Lady Linklater of Butterstone. This strand includes the establishment of a new national college for school leadership, a more coherent framework for leadership training and enabling schools to extend their leadership tier beyond heads and deputies. To attract future leaders we also propose a national fast-track programme for high quality graduates and serving teachers capable of rising quickly through the profession. I shall return to that point a little later if I have time.
	Many speakers in this debate have raised the issue of performance pay. I wish to spend a little time discussing that. The second strand of our reforms is designed to provide better rewards and a better career structure for classroom teachers. I entirely agree with the noble Lord, Lord Pilkington, as regards the importance of providing the right rewards for our teachers. Under the present system teachers have an effective salary ceiling of £23,000, unless they take on management responsibilities. We want to strike a better balance between rewarding good teaching and recognising other responsibilities. That is what the proposals for a performance threshold and upper pay spine, which we put to the School Teachers Review Body, concern. I say to the noble Lord, Lord Smith of Clifton, who I thought indulged in a certain amount of purple prose in this respect, that this is far from being an exercise in futility. The threshold is central to our proposals for reforming teachers' pay and its purpose is to reward teachers for good classroom performance.
	Every teacher with nine points for qualifications and experience would be eligible to apply. Schools will receive application forms and guidance at the end of March. Teachers who want to apply this year would be expected to put in their applications by the beginning of June and the application form would ask them to provide evidence that they met specified national standards of teacher effectiveness. Heads would assess teachers' applications against those standards. To help them do that, every head would have the opportunity to attend a training conference on assessing applications. To ensure national consistency heads' assessments would be verified by external assessors. Passing the threshold would give teachers an immediate pay increase of up to £2,000. There would be no quota on threshold successes. I say to the noble Baroness, Lady Blatch, that schools will get the extra money they need to pay for every teacher who crosses the threshold. A special grant will be established to cover that.
	The Government have allocated £1 billion over the next two years for the teaching profession reforms. The bulk of this will be allocated for pay. In time the national standards used for the threshold should also inform the new performance management arrangements for teachers which will replace the present appraisal regulations. We know that teachers want to provide the best possible education for their pupils; systematic performance management will help them to do that.
	There have been a number of further detailed comments about performance pay which time does not allow me to go into. I shall write to noble Lords about them. I should like to say to the noble Baronesses, Lady Perry and Lady Sharp, that we believe it is right that good teaching should be rewarded. We believe that the scheme that we are introducing will become accepted by the profession. Indeed, there are already signs that it is doing so. The starting point for the new system will be teachers agreeing objectives with their head or other team leader.
	Let me turn now to training. Performance reviews will certainly identify development needs. So performance management will feed into the third strand of our reform programme, which is about better training and professional development. Effective professional development is of course crucial to raising the status of the teaching profession and to raising standards in our schools. Raising standards means continuous improvements by pupils--and that cannot be achieved without teachers continually developing their knowledge and skills. I am sure there is agreement about that. That is why professional development is such a key part of our national strategy. We intend to set out a clear national framework to bring together national, school and individual priorities for continuing professional development. I shall not apologise to the noble Lord, Lord Tope, if he considers that that is another new initiative.
	My noble friend Lord Dormand of Easington and the right reverend Prelate the Bishop of Blackburn mentioned the issue of initial teacher training. We are also starting from the beginning by developing more flexible and rigorous initial training for teachers. I agree with the right reverend Prelate--I think the noble Baroness, Lady Blatch, also said this--that teaching is a vocation; it is not just a job of work that has to be done. So we shall be introducing changes to the initial training which we believe will meet that commitment.
	The noble Lord, Lord Pilkington, mentioned the new skills tests for trainee teachers in numeracy, literacy and IT. That is another important part of our reform programme. Recent evidence from Ofsted has confirmed that the literacy and numeracy standards for a significant number of teachers in our schools are not good enough. The new skills tests will ensure that newly-qualified teachers have the skills that are needed to carry out their professional roles effectively.
	The fourth strand of our programme is about offering better support to help teachers get on with the job. This includes extra money to recruit 20,000 more teaching assistants. It also includes grants to improve the working environment for school staff and for administrative support for small schools, a point mentioned by the right reverend Prelate the Bishop of St Albans. We are looking at ways of reducing the amount of overload that teachers have had to deal with for many years, an issue to which the right reverend Prelate referred.
	Taken together these four strands make up what the Prime Minister has called the most fundamental reform of the teaching profession since state education began. This reform programme is a crucial part of government policy precisely because of the importance we attach to individual teachers and the profession as a whole. The future of this country, quite literally, is in their hands.
	Against this background I shall now turn to some of the other issues that have been raised in the debate. A number of noble Lords referred to issues surrounding recruitment to the teaching profession. Recruitment to primary initial teacher training is buoyant--for 1999-2000 it was up by 3 per cent and on target--but we still have problems in some secondary subjects. We are trying to address these problems. We have introduced £5,000 incentives for students doing secondary maths or science PGCs and taking up posts in this area. As a result, recruitment to maths teacher training is up by 16 per cent compared to the same time last year, and science is up by 3 per cent. The noble Baroness, Lady Blatch, asked about that. The incentives will be extended to modern foreign languages from next September.
	In the longer term, our Teachers' Green Paper will create a new structure for the profession founded on better leadership for all schools, better pay for good teaching, more training of a higher quality for all teachers and improved support. That will help with the recruitment problems.
	The noble Baroness, Lady Blatch, and the noble Lord, Lord Tope, asked specifically about London. There is an allowance for teachers in London of £2,241 per year and, in addition, schools can pay up to three points on the pay spine to classroom teachers employed in posts which are difficult to fill. I hope that that will help the particular problems in the capital to which both the noble Lord and the noble Baroness referred.
	I shall write to the noble Baroness, Lady Blatch, with some of the more specific details she asked for on mismatches between teachers' qualifications and the subjects that they are teaching.
	Let me turn now to the issue of teaching assistants, about which the noble Baroness also asked. The Government recognise the value of teaching assistants in helping to achieve higher standards in our schools. We have already announced our intention--I think I have mentioned this--to increase by 20,000 the number of full-time equivalent teaching assistants working in our schools by 2002. An extra £130 million in the next financial year will allow LEAs to recruit up to 15,000 more assistants, with the remainder to be recruited the following year. Work is also in hand to develop a national framework of training and qualifications which will clarify the role of the teaching assistant and help to give these people the qualifications that they need.
	I thought that the noble Baroness, Lady Perry, was perhaps a little negative and pessimistic when she discussed the perceptions that young people have about going into teaching. My noble friend Lord Dormand was closer to getting this right. The Teacher Training Agency commissions regular research on how school pupils and undergraduates view teaching as a career. I am very pleased to say that recent evidence is that it remains fourth as a choice of career. In a separate MORI poll in 1999, 46 per cent of younger pupils thought teaching was a rewarding job, and 39 per cent thought that teachers were well respected. The Green Paper reforms should drive these figures up and create the scope to encourage and reward the creativity in the classroom to which the noble Baroness, Lady Perry, referred.
	There has been reference in the debate to the fast track. The fast track is at the core of our vision of an excellent teaching profession and we believe that it is a way of encouraging really high quality graduates to become teachers. We hope that they will then be the most talented and dedicated serving teachers. Any school will be able to offer a fast-track teaching post with challenging objectives and opportunities, and to recruit from fast-track applicants.
	The right reverend Prelate the Bishop of St Albans referred to wastage rates of teachers who leave the profession. Again, the Teacher Training Agency is working to try to reduce the number of people who leave and to help those who have done so to come back later. It is funding a number of courses specifically for those who want to return to the profession. We shall monitor the extent to which that is successful.
	I should like to say a few words about standards, a subject that has been touched on in the debate. It is still early days, but I believe that there are already signs of progress. Attitudes are changing, in spite of what has been said by some speakers in the debate. In 1998 the literacy and numeracy strategies were criticised as central government prescription. Now almost 90 per cent of primary heads support the literacy strategy and 70 per cent went so far as to adopt the numeracy strategy early.
	Standards are beginning to rise. Over the past year the number of failing schools has fallen steadily and the average time it takes to turn around a failing school has come down from 25 months to 17 months. Those figures are a tribute to our teachers.
	In response to the comments of the noble Lord, Lord Tope, testing is about raising standards in our schools. It is not about collecting information for its own sake. The percentage of pupils leaving school with no qualifications has fallen for two consecutive years, while the percentage of pupils achieving higher grade GCSEs has increased each year. Again, that is a tribute to the professionalism of our teachers.
	Most importantly, the percentage of 11 year-olds achieving the standards for their age rose significantly last year. In May 1997 just 57 per cent achieved the standard in English; that rose by 13 per cent to 70 per cent in 1999. In May 1997 only 54 per cent achieved the standard for their age in maths; that rose by 15 per cent to 69 per cent in 1999. We are well on track to hit the 2002 target.
	This is good news, but there is still some distance to go before we can match the best worldwide. We shall be working to try to achieve that. Teachers are of central importance to driving up these standards. For that reason, we are committed to the extra funding that I have already mentioned to strengthen the profession.
	Teachers are also integral to the success of Excellence in Cities which requires them to work collaboratively with teachers in other EiC schools to come up with new solutions to old problems. Our education action zones are intended to raise levels of attainment for pupils in challenging circumstances, but also--and crucially--to provide the teachers working in those schools with the additional resources and support they need. Teachers are involved in drawing up the activities taking place in individual zones and schools through working groups, staff conferences and direct forum membership.
	I agree that it is right to praise teachers and to show confidence in what they are doing. That is what this Government are doing. Many of our initiatives are designed to support our teachers and to build on that confidence.

Baroness Perry of Southwark: My Lords, it only remains for me to thank all noble Lords who have spoken in the debate. We have had a very high quality discussion and a most excellent maiden speech on which I congratulate the right reverend Prelate the Bishop of St Albans.
	There has been a remarkable unanimity of message from all speakers and I hope that the Minister has taken on board the concern that has been expressed from all sides of the House about the low morale in the teaching profession and a sense of far too much being imposed from the centre. I know from personal experience--perhaps I should say mea culpa here--that reforms, from the point of view of the higher reaches of the Department for Education and Employment, can look much more attractively simple than they do from the point of view of the classroom.
	However, I do not feel pessimistic. I believe that there are some good signs and I feel great optimism about the position of the noble Lord, Lord Puttnam, as chair of the GTC. I think that much work needs to be done there and I believe him to be the right person to do it.
	In particular, I hope that the Minister will not remain too complacent about how simple it is to raise the morale of teachers. At the moment both she and the country have a problem in this area. I shall not feel truly enthusiastic and hopeful about recruitment to the teaching profession until I see a considerable improvement in the A-level grades of those being recruited for the B.Ed. However, we have had a very good debate and I beg leave to withdraw my Motion.

Motion for Papers, by leave, withdrawn.

Disqualifications Bill

Brought from the Commons; read a first time, and to be printed.

Gulf War Veterans: Illnesses

Lord Morris of Manchester: rose to ask Her Majesty's Government what further consideration they have given to setting up a public inquiry into the undiagnosed illnesses of Gulf War veterans, as called for by the Royal British Legion.
	My Lords, I have an interest to declare, but not a financial one, having been honorary Parliamentary Adviser to the Royal British Legion for many years; nor does my membership of the Inter-Parliamentary Gulf War Group, which has a keen interest in the outcome of this debate, have any financial implications. Other members of the group, ably chaired by Colonel Terry English of the Legion, include the noble Countess, Lady Mar, and the noble Lord, Lord Burnham, Michael Mates MP and Paul Tyler MP; representatives of the ex-service charities; Major Ian Hill and Flight Lieutenant John Nichol from the veterans' associations; and senior doctors and nurses. Inevitably my approach to this debate is influenced also by my upbringing as the son of a war widow and by active service in the Middle East during my own years in the forces.
	This evening's "cast"--as it were--has changed since the previous debates I initiated on Gulf War illnesses; but the purpose of this further debate is the same as before. It is to seek due priority for the claims of men and women who were prepared to lay down their lives in the service of this country in the Gulf War and the dependants of those who did so.
	The noble Earl, Lord Effingham, who, with his customary quiet authority, spoke with such distinction in the debate I opened on 24th March 1999, is sadly no longer in the House. Many of us hope to see him return to the Cross Benches, informing our debates on the problems and needs of the ex-service community as he did so often and so effectively over recent years. The noble Lord, Lord Burnham, who is abroad, was kindly in touch before he went to let me know how sorry he was not to be able to join us again this evening; and no doubt my noble friend Lord Gilbert, whose concern and courtesy in replying for the Government to so many previous exchanges on the problems and needs of Gulf War veterans were much appreciated, will be looking with some nostalgia on our proceedings this evening.
	Meanwhile, I welcome his successor as Minister of State, my noble friend Lady Symons, who I know will want to respond as helpfully as she can to the debate; and I am grateful to her for sending me the three MoD papers published on 20th January. One reviews the available evidence on the suggested exposure of UK forces to chemical warfare agents in Al Jubayl on 19th January 1991; the second is a report on the implementation of the anti-biological warfare immunisation programme during the Gulf conflict; and the third is the MoD's response to the audit of the Gulf Veterans' Medical Assessment Programme. The Legion, having also received the three papers, states:
	"They are, of course, welcome and helpful, up to a point. But they add little to what is already known. Their contents would form a valuable source of evidence for the public inquiry".
	My Lords, I agree.
	I appreciate of course that my noble friend the Minister, like her ministerial predecessors who spoke for the Government in earlier debates, has the difficulty, when she comes to reply, that the Ministry of Defence is not the only department with an interest in Gulf War illnesses. Among other departments, the DSS and DoH also have an interest, as does the Treasury, which is why the Legion pressed for an inquiry at a level which would call for appointment by the Prime Minister and not by any departmental Minister.
	In seeking the inquiry, as Brigadier Ian Townsend, the secretary-general made plain, the Legion was,
	"very conscious that in the United States a Presidential Commission was established very soon after the conclusion of the war",
	and that a public inquiry of comparable standing here,
	"would be providing our veterans and service people with no more than parity of treatment".
	This year marks the 10th anniversary of the Iraqi invasion of Kuwait that triggered the Gulf War. Thousands of the men and women we deployed, then fit and well, now have to live with debilitating illnesses, some very severely disabling. Of the 413 veterans who have already died, 67 took their own lives, with devastating consequences for their families.
	Thus no one can argue that the Legion acted precipitately in calling for a public inquiry into all aspects of the handling of the Gulf War illnesses. It did so in May 1998, in a motion that was unanimously approved by its annual conference, to which the Prime Minister was asked to give urgent effect. It took over 16 months for a response to come, in a letter rejecting the call for an inquiry from my honourable friend John Spellar MP, the Minister of State for the Armed Forces, to whose predecessor at the Ministry of Defence the Legion's representations to the Prime Minister had been referred.
	Reacting to this in a letter to me dated 11th November 1999, Ian Townsend said the rejection of the motion had caused,
	"considerable bitterness among Gulf War veterans".
	He added:
	"Indeed the Legion membership, as a whole, will be angered by it".
	He went on to ask me to appeal to the Prime Minister to reverse the decision; and I did so in a letter to my right honourable friend dated 16th November. My letter emphasised the strength of feeling in the ex-service community, made it clear that the Legion wanted an inquiry that would go wider than the responsibilities of any one department and pressed for reconsideration of the decision conveyed in John Spellar's letter. To date there has been no reply.
	For the Secretary-General of the Legion to write in terms of "bitterness" and "anger" is not only unusual. In my experience, it is unprecedented; but Ian Townsend's letter to me of 11th November in no way overstated the strength of feeling among Gulf War veterans--many of whom talk of being treated by Whitehall as "yesterday's people"--or that of the Legion membership more generally.
	They argue that an urgent, independent and wide-ranging inquiry is imperative not only in fairness to those afflicted, but to restore public confidence and demonstrate to our armed forces that they will be thoroughly prepared and protected in future deployments. The Legion membership wants past mistakes in the handling of post-Gulf War treatment of veterans to be investigated by the inquiry:
	"working concurrently with the scientific and medical studies to minimise further delay".
	The inquiry they seek would be empowered also to look into complaints about the setting up, funding and progress of these studies; to compare them with the much more urgent and comprehensive studies prompted by the Presidential Commission in the United States; and to examine the extent to which failures in the MoD's Medical Assessment Programme, MAP--which I know the noble Countess, Lady Mar wishes to address--have alienated and demoralised many veterans.
	The inquiry could examine as well questions raised in parliamentary debates that still remain unanswered. For example, I asked in previous debates how many of the Gulf War veterans who had committed suicide since the conflict were service men and women with post-traumatic stress disorder and how many, successfully or otherwise, had applied for a war pension for the disorder. That question remains unanswered, as does the point I made in the debate on 24th March 1999 about the failure of MoD's report on the use of depleted uranium to attempt any estimate of the combined and interactive effects of exposure to depleted uranium and of all the inoculations and injections that were administered to those who served in the Gulf.
	Other important questions raised in parliamentary debate that remain unanswered include one put to me in a helpful note from the noble and gallant Lord, Field Marshal Lord Bramall, before the debate on 24th March 1999--namely,
	"Why tests were not done as soon as possible after the conflict into the effect of the cocktail of inoculations and injections given to our service men and women who went to the Gulf, all administered at the same time, on the human immune system. Or why if tests were done the results have never been published?"
	No less disturbing are the long delays in replying to representations about the cases of Gulf War veterans made by letter. My noble friend wrote to me on 6th December 1999 about the case of Justin Harvey, who lives in Stoke-on-Trent. Her letter was in a reply to representations I made on 8th June. The delay of six months in replying was not the fault of my noble friend; nor I suspect was it that of her immediate predecessor. In fact long delays in dealing with representations for Gulf War veterans were common before the present government took office. The fault seems deeply rooted in flawed administrative arrangements for dealing with veterans' complaints. Nevertheless, the average time taken to deal with them by the MoD and DSS alike alone warrants an inquiry.
	Again, the inquiry The Royal British Legion is seeking could establish why service men and women have not been given copies of their medical records on discharge to assist their GPs in the early diagnosis of illness that could be attributable to their service. It could address also serious questions about the consequences for individuals of lost or incomplete records, could identify culpability in past cases and could consider changes in current procedures for keeping records.
	I have had assistance in preparing for this debate from Dr Peter Heaf, the Legion's highly respected medical adviser. His first concern is that we must learn from experience in the Gulf War if our forces are to be made safer in future deployments. He asks whether Ministers are aware of developments in the US in relation to their Centres of War Related Illness, which concentrate on exposure information, on clinical examination, on education and, perhaps most important of all, on the assessment of risk factors prior to deployment.
	Dr Heaf is concerned also about failure to publish the report of the fact-finding team set up in September 1997 to look at the implementation in theatre of the 1991 programme of immunisation; the absence so far of any report of the evidence taken from representatives of Gulf War veterans by the Defence Select Committee; and failure to make clear whether any research has been undertaken to investigate the extent to which the effects of vaccines, pyridostigmine bromide--NAPS--and OP pesticides can change when they are administered to service personnel under stress.
	Among the most memorable personal recollections of the Gulf conflict I have read is one on the effects of setting Kuwait's oil fields on fire. The recollection is that of Squadron Leader Philip Congdon of the RAF, as he then was, who led the training team sponsored by the British Government that went to Saudi Arabia after the invasion of Kuwait to train expatriate Saudi Arabian military and civil defence personnel in chemical and biological warfare defence. He writes:
	"Everybody who was present in the Gulf will remember the smoke cloud generated after the oil fields were set on fire. The result was not a fog but rather the pollutants, held by ugly thick smoke, which rose into the atmosphere producing a dirty sable black dome that extended from horizon to horizon over Kuwait and often drifted well into Saudi Arabia. Within this dome a mist of oil particles would occasionally precipitate. We now know that the atmosphere was saturated with pollutants of the most profoundly life-destroying type".
	But what research has been done on the health effects on British servicemen and women of releasing into the atmosphere--which is what the burning of six hundred oil wells achieved--of 50,000 tons of sulphur-dioxide, 100,000 tons of soot and 85,000 tons of carbon-dioxide every 24 hours? Air samples detected the presence of carbon monoxide, nitrogen oxide and polycyclic aromatic hydrocarbons, together with benzine, cadmium copper, molybdenum, nickel, lead, vanadium and zinc in "above average" concentrations? Squadron Leader Congdon describes what happened as,
	"passive smoking of the most deadly type",
	and it was shared with the Kuwaitis and Saudis by British personnel. Anyone who thinks exposure to pollution on that scale was but a passing inconvenience for those affected by it ought to speak, as I have done, to public health officials in Kuwait. After visiting Kuwait and talking at length with Ministers there, including the Minister of Health, I was left in no doubt that much could have been gained from increasing our knowledge of the effects of the Gulf conflict on public health in Kuwait. I hope my noble friend will comment on this when she comes to reply.
	My noble friend Lord Gilbert was always most helpful after previous debates in pursuing with the DSS cases that were raised from both sides of the House of Gulf War veterans with undiagnosed illnesses who were in dispute with the War Pensions Agency. I shall be grateful for any help my noble friend Lady Symons can give in having urgently resolved some especially disturbing cases of which I shall let her have details. Taken together, they are described by the RBL as,
	"nothing short of shocking".
	There is time for me to cite but one case tonight--that of a man from Leigh in Greater Manchester, who served in the Gulf with 2 Field Regiment RA. Such has been the deterioration in his health since the conflict that he is now subject to severe depression, panic attacks and acute breathing difficulties. On two desperate occasions he has tried to end his own life. His wife has to remain at home to care for him and they now rely totally on state benefits, including both the care and mobility elements of Disability Living Allowance.
	Four independent psychiatric and medical assessments have been sent to the War Pensions Agency, confirming post-traumatic stress disorder in this case, including two from Dr Nick Cooling, of the Combat Stress Centre at Audley Court, and Dr Malik of Leigh Infirmary. Where a Gulf War victim is already in such poor health--with job prospects described as between "minimal and non-existent"--surely it is right that an appropriate award should be made without further delay.
	None of us here, wherever we sit in this House, wants to see those afflicted in the Gulf made to suffer the added strain and hurtful indignities that long delay in dealing with their rightful claims can impose. There was no delay in their response to the call to duty. Nor can there be any excuse for preventable delay now in meeting in full our debt of honour to them. That is what the Royal British Legion's work for them is all about and it is much the best way of showing our regard and admiration for those who served us with such gallantry in the Gulf War 10 years ago.

Baroness Park of Monmouth: My Lords, we all owe a great debt to the noble Lord, Lord Morris of Manchester, for enabling us to talk yet once more about this immensely important subject.
	The noble Lord, Lord Robertson, when Secretary of State, wrote in his preface to the MoD paper, published in July 1999, Defending against the Threat of Biological and Chemical Weapons, that to know what the biological and chemical weapons threat is, how to reduce it and how to protect against it, is
	"a constantly developing process to which we are firmly committed".
	He added that he regarded it as one of his highest priorities. That the MoD accepts that the continuing, and as yet unresolved, problems of the Gulf War veterans form part of this process is confirmed by the inclusion of the MoD Gulf War Veterans Illness Unit Internet site among the major source references quoted in the paper. It is indeed vital for the MoD to learn from its failure to talk to the veterans at a far earlier stage. They, after all, were there.
	Why then, nearly 10 years after they were exposed to biological and chemical attack, are the Gulf War veterans still denied recognition of their illness and still denied in many cases the pension and benefits to which they are entitled? Successive governments have, under pressure from the noble Lord, Lord Morris of Manchester, the redoubtable noble Countess, Lady Mar, and indeed the Royal British Legion, produced papers such as Gulf War Veterans Illnesses: A New Beginning in 1998. That was indeed a significant paper and a milestone on the way. Unfortunately, not very much happened after that.
	Under pressure governments have instituted research, but, again, only after a long delay. We have had the MoD's Medical Assessment Programme--MAP--launched with grossly inadequate resources--Group Captain Coker and one other, and eventually Group Captain Coker on his own--in 1996, then resumed in 1997 and 1998. We had the King's Fund Survey which did a management audit of MAP, and we had research by the Medical Research Council, both begun under the previous government. There followed MoD funded epidemiological studies into the health of Gulf War veterans in general. One at Manchester University was due to report in mid-1999. Can the Minister say whether it has been published. Another was by the London School of Tropical Medicine.
	In March last year we were told that by then about £2 million had been spent in research into Gulf War illness, and the Government expected the research programme to cost a total of £5.9 million. Yet all this time after the Gulf War, the veterans are still waiting for what I can only call the barest basic justice. By March last year 381 were already dead--I was shocked to hear how many had committed suicide--and those alive are still struggling just for recognition that they are ill. Those illnesses, in their various painful and debilitating manifestations, arose from their service. Still after all this time they are struggling for pensions and benefits.
	The Minister told us in March last year that the Government had appointed two new doctors to the Medical Assessment Programme, presumably as a result of the management audit. In view of the appalling state of the grossly underfunded, undermanned Defence Medical Services in general, we should be grateful for that if these had been consultants, or even partly conversant with the medical and other conditions from which the veterans suffer. However, the accounts we had in debates both in 1998 and 1999 of the treatment meted out to some of the veterans by these two MAP doctors, who were said to have dealt with some of them as if they were malingering wimps and to have refused to look at their records, suggests that these may have been doctors with no specialised knowledge whatever. At least one was said to be under instruction not to offer the veterans treatment as that would create a precedent. How does that square, I wonder, with the MoD commitment, set out in the paper on Gulf War illnesses, that MAP would work with the Department of Health on this very thing? We were told, incidentally, that MAP costs £750,000 a year to run. Has that been cut?
	Those men and women and their families have a right to be treated honourably and fairly. Long overdue and protracted research has demonstrated that they have real and serious health problems attributable to their service, which are exacerbated by the stress of needing to fight to be believed. They are dying off year by year and must by now have lost hope of decent treatment. As the noble Lord, Lord Morris of Manchester, said, there have been suicides in that small group. They must look with envy at the US Government's very different record. I hope that the Minister will tell us whether our continuing exchange of information with the Americans has had any useful practical results.
	The main issue now is how to get the War Pensions Agency, the Department of Health and the DSS to do what is needed and to do it quickly; and how to secure treatment when the need for that is demonstrated. The veterans have always said that they do not want to litigate but simply to be able to have their claims recognised and to receive the benefits to which they are entitled. That must happen and be seen to happen without delay. I shall turn later to possible action to achieve this.
	There is, however, an important issue of justice and good governance which calls for a thorough and immediate public inquiry into the performance of the War Pensions Agency, the DSS and the MoD, an inquiry which we were told last year would be considered. Since I wrote my speech, I have heard from the noble Lord, Lord Morris of Manchester, that that has been turned down. I had not realised that. We know, alas, from the Organophosphate Pesticide Investigation Team's report of 6th December 1996--OPIT--that there has been over years serious incompetence, muddle and bureaucratic delay in various places, and that standards of professional competence have been low. Evidence to the Defence Committee confirmed that as far as concerns the MoD. I do not know whether the other two departments have been called to account.
	It would be reassuring to know whether, after the formal reprimands were administered, action was taken to ensure against any repetition of such incompetence as the "failure in medical record keeping" which led to the loss of over 15,000 medical events. These, as the MoD admitted to the Defence Committee, included data relevant to some of the Gulf War veterans. Because the events could no longer be attributed to the individuals concerned, this may well have deprived them of important evidence needed for the preparation of their case.
	But is the real problem a subliminal but nevertheless well-understood policy of delay dictated by the termites in the Treasury, designed to delay payments as long as possible? Time is passing; some claimants are dead, others may weary of the battle. Can we allow that to happen? We have to consider how the veterans perceive the matter.
	The Government should understand clearly that there is a major issue of confidence here. Morale in the Armed Forces, thanks to a combination of overstretch and under-manning and of covert financial cuts, is at an all-time low. Men and women of the forces will be watching to see what treatment the veterans receive. They have seen the Defence Medical Services cut to the bone. Now they see how they can expect to be treated in the aftermath of war. This is the kind of issue which could constitute in their eyes one more reason for them to leave the services--and they are not short of reasons at the moment. They can scarcely be encouraged by what they see in this case.
	What we need to do is look at the delivery of pensions, benefits and treatment. As long ago as March 1998 we heard of long waits for pensions and were told that although, allegedly, 219 pensions had been granted out of 425 claims, in fact, according to the solicitors working for the veterans no case had (at that time) yet been settled. The Minister undertook in our last debate to look at the interface between the MoD and the War Pensions Agency. The difficulties and delays have continued.
	I said on a previous occasion that I hoped there were no more unexploded time bombs of unrevealed mistakes, and I hope that the OPIT report did find all there was to be found. I am the first to understand the importance of "need to know", but it should never be used to protect incompetence at the expense of the victims of that incompetence--in this case, people who have fought for their country. I understand the pressures on many public servants, but I am concerned at the way, often insensitive, in which the veterans are sometimes treated, and the time that it took to act. Why were they not consulted long ago, when they first began to say that they had problems?
	Research is necessary, of course, and it takes time. I recognise that public money cannot be spent without good foundation. But that has been amply proved and re-proved. It should have been undertaken much earlier. Now, we have to get on with it. I recognise that the Government have tried to repair the fault. Nevertheless, there is much to do.
	A public inquiry may be the only way in which justice can be seen to be done. But I hope that its chief task would be to establish effective machinery immediately to secure action in the field of pensions, benefits and treatment. I should not like to see a long drawn out inquiry which succeeded only in kicking action into the long grass and finding scapegoats. That was done by OPIT to some extent.
	There is now a Gulf War unit in the MoD. I suggest that similar units should be set up in the War Pensions Agency, the Department of Health and the DSS respectively, to which all Gulf veterans' cases could be directed for action in conjunction with the MoD as necessary. Incidentally, this issue has arisen in previous debates in which the noble Countess has spoken where there has been an overlap on organophosphate issues between the Department of Health and other departments. So there is a precedent. Those appointed should have proper powers to act within their ministries along agreed guidelines, and there should also be an independent ombudsman to whom veterans could appeal if they still encounter obstruction and delay. After 10 years of waiting, and of research and consultation, there should be no need for any further bureaucratic delay and it should not be tolerated. I am not talking about a consultative machinery, but about powers of execution. A point of appeal will also be necessary, with sufficient power to secure speedy action.
	I hope that in this case, since it was the Prime Minister to whom the appeal for an inquiry was made in 1998, he might be asked to think again, and to make it absolutely clear to the relevant ministries that, in the old and honoured phrase, action this day is required of them, and that joined up writing, to use the present phrase, is the order of the day. Action is required of them, and on this occasion at least the Prime Minister must make sure that the Treasury does not have the first, last and only word, or at any rate the wish to save the public purse above all else. Men and women are valuable resources too. We cannot afford to under-value them. Nor can we afford to lose their trust in us.

The Countess of Mar: My Lords, I am grateful to the noble Lord, Lord Morris of Manchester, for his timely tabling of this Question. I am also delighted to follow the noble Baroness, Lady Park, who has such wide experience of the internal workings of Whitehall and government and speaks with such knowledge.
	I declare an interest in that I am patron of the Gulf Veterans Association. Noble Lords may not be aware that I became interested in the plight of Gulf veterans when in 1993 they began to report their symptoms. I was struck by the remarkable similarity between their illnesses and those of sheep farmers who had become ill after exposure to organophosphate sheep dips. I still believe that there is a connection between the illnesses of the veterans, anticholinesterase pesticides and medication, although I do not believe that they are the only cause.
	Not only is there a similarity between Gulf veterans and sheep farmers: no one who has been associated with either or both of these groups for any length of time can have failed to notice that the two government departments responsible for commissioning research into the causes of the illnesses have mirrored each other in their dilatory management of the problems. At first the sufferers were all wimps. Then there was no evidence that any of the factors to which either group attributed their symptoms was unsafe. I found myself repeatedly reminding those who looked only at current evidence of Toyber's Dictum:
	"Absence of evidence is not evidence of absence".
	Those men and women, many of whom were reservists or members of the Territorial Army, responded to the call to arms in the belief that their country would care for them if their health should be harmed as a result of their service. Instead, they have found that, following the Gulf conflict, they have had to fight inch by inch to convince the Ministry of Defence that their illnesses are real, that they are not the result of post-traumatic stress disorder or of psychological origins and that they do have an organic cause.
	As the noble Lord, Lord Morris, said, the Royal British Legion originally wrote to the Prime Minister to ask for a public inquiry into Gulf War illnesses on 11th June 1998. Despite a number of reminders, it was not until 26th October 1999 that a reply was produced. I was astonished to find that the decision not to hold a public inquiry had been delegated to the Minister for the Armed Forces. It may help if I read the first sentence of the letter from the British Legion. It states:
	"At the Royal British Legion Conference in Blackpool on 24th May, delegates unanimously passed a motion calling on you, as Prime Minister, to commission a public inquiry into the way in which the aftermath of the Gulf War has been handled".
	Brigadier Townsend went on to detail the reasons for the request.
	In his response to the letter, the Minister for the Armed Forces, Mr Spellar, begins:
	"In June 1998 you wrote to the Prime Minister requesting a public enquiry into aspects of Gulf veterans' illnesses".
	My Lords, he did not. That statement was disingenuous, to say the least. In his penultimate paragraph, Mr Spellar states that he has,
	"considered very carefully this issue and concluded that a public enquiry will simply not be able to answer the question of why the Gulf Veterans are ill".
	He made no attempt to address the questions posed by Brigadier Townsend.
	Surely, in view of the fact that the Prime Minister and the Secretary of State for Defence could have been in no doubt as to the scepticism with which the Gulf veterans viewed the actions of the Ministry of Defence, an independent person should have been brought in to make the decision. I ask the Minister: why was that not done, and was it even considered?
	This week sees the ninth anniversary of the end of the air war and the start of the land war in the Gulf. It is at least eight years since veterans started to complain of unusual illnesses. Some 428 (here I correct the figure given by the noble Lord, Lord Morris) young men have died from diseases associated with their service in the Gulf or have committed suicide. In all that time only one research programme has been completed. That was an epidemiological study funded by the American Department of Defense which found that Gulf veterans did have a higher level of reported symptoms than the control groups but carried with it the inference that they were more likely to be of psychological than organic origin. Subsequently, the same research group has been funded to conduct neurological studies on the veterans. The group would appear to be in some difficulty, as I understand Professor Wessley has recently informed the US Department of Defense that few subjects have come forward for further examination and, as a result, he believes that the British Gulf veterans must have got better. I wonder whether he has considered alternative reasons for their lack of response.
	I am sure we all acknowledge that trust is an essential ingredient in any doctor/patient relationship. When the Medical Assessment Programme was set up in 1993 under the leadership of Group Captain Coker the veterans trusted him implicitly. When he was succeeded by a string of seemingly unsympathetic and in some cases incompetent doctors, the veterans lost their trust in the programme. The MoD appears to rely entirely upon the MAP for its evidence on veterans' illnesses, yet Professor Harry Lee, who is currently head of the Medical Assessment Programme, personally stated to the independent panel on 29th March 1999 that the MAP was not there to treat Gulf illness. He gave the impression that there was little, if any, communication between MAP doctors and veterans' GPs, despite the fact that MAP doctors arranged for clinical tests to be conducted and presumably it was they who got the results. Professor Lee seemed to have very little concept of the extent to which veterans were exposed to toxins or the manner in which medication was administered to them. The MAP is not now involved with research. Can the Minister say, first, exactly what is the purpose of the MAP and, secondly, when is the promised clinical audit to be carried out?
	I move on to research. The letter of the Minister for the Armed Forces to Brigadier Townsend made much of the research currently being conducted. There is only one clinical study which, as I explained earlier, seems to be in trouble. There are two epidemiological studies, one at the University of Manchester and the other at the London School of Hygiene and Tropical Medicine. All that these studies tell one is whether there is a higher incidence of mortality, morbidity or birth defects in the children of the Gulf community. They will not tell one which veterans are suffering from what illnesses or how they should be treated.
	I recall the noble Earl, Lord Howe, advising me that the Medical Research Council had informed him that no causal research was necessary. I do not know what it said about clinical research, but it is clear that no proposals for clinical research to the Gulf War Illness Panel of the MRC, apart from the King's College study, have been funded. In paragraph 42 of its July 1997 statement Gulf Veterans' Illnesses: A New Beginning one sees the following statement:
	"New and potentially important ideas in the field of Gulf health research are being suggested by the scientific community all the time. Accordingly the Government encourages those with interest in this subject to submit proposals for further work to the MRC for consideration".
	I ask the Minister just how many new research proposals have been received and accepted since the Gulf War Illness Panel of the MRC was set up, particularly since July 1997. How many of those whose applications were rejected were given reasons for the rejection? I also understand that neither the Interactions research at CBD Porton Down nor the anthrax and pertussis vaccine research to be undertaken by the National Institute for Biological Standards and Control has begun.
	In 1997 the Burton Committee in the USA reported:
	"After 19 months of investigation and hearings, the subcommittee find the status of efforts on the Gulf War issues by the DOD, VA, CIA, and FDA to be irreparably flawed. We find these efforts hobbled by institutional inertia that mistakes motion for progress. We find these efforts plagued by arrogant incuriosity and a pervasive myopia that sees lack of evidence as proof. As a result, we find current approaches to research, diagnosis and treatment unlikely to yield answers to veterans' life-or-death questions in the foreseeable, or even far distant, future".
	That could have been written about our institutions and, sadly, it still appears to apply here. Since that committee reported the culture of denial has changed in the USA. We should compare the miserable outlay by this and previous governments on Gulf-related issues with the enormous expenditure of the United States Government in this field. We should compare the number of research projects that receive funding in the United Kingdom with those in the USA. Men and women from both countries fought side by side, received similar medication and were exposed to the same toxins.
	The United States Government have accepted that their veterans are ill from Gulf service. Of the nearly 700,000 US troops who served in the Gulf, 83 per cent are eligible for benefits through their Veterans Agency and 45 per cent have sought medical care at the VA. The US Government have accepted that 100,000 US troops were exposed to repeated low levels of chemical warfare agents; that more than 250,000 received pyridostigmine bromide, which the Pentagon cannot rule out as being linked to Gulf illnesses; that 150,000 received the hotly-debated anthrax vaccine; that more than half their force entered or lived for months in areas contaminated by more than 315 tonnes of depleted uranium and radioactive toxic waste; and that thousands of them lived outdoors for months near 700 burning oil wells that belched fumes and toxic particles day and night. If the US Government accept these facts, why do ours continue to deny them?
	Only last week I received a copy of two internal MoD reports, to which the noble Lord, Lord Morris, referred: one on the immunisation programme and the other on chemical weapons. I read them very carefully. I ask the Minister whether, in view of the time which has elapsed since the Gulf conflict and the clear gaps in factual information highlighted in both these and previous reports, Her Majesty's Government will immediately acknowledge the probability that our Gulf veterans are ill as a result of their service and that, as the US Government have done, they will immediately implement measures to ensure that all our sick veterans receive proper clinical assessments and treatment on the basis of their known exposures. The veterans know to what they were exposed.
	I pay tribute to all those Gulf veterans who have worked so hard over many years to establish the facts. Far too often a brick wall has faced them, but they have never lost their courage or determination. They have established contacts with Gulf veterans from other countries, scientists from many specialties and politicians. Despite the failure of the MoD to grasp the nettle, these veterans have continued to meet and co-operate with officials and Ministers and offer them information. These men and women are ill and are tiring. I do not believe that that is what Ministers have been waiting for, hoping that they will go away. They deserve better.
	I wholeheartedly support the repeated call by the Royal British Legion for a public inquiry which would allow for a full investigation of the failure of the MoD to act promptly when the alarm bells began to ring in 1993. That inquiry would examine the management of the MAP, the research programme, war pensions and other social security benefits in the period since the conflict; it would bring facts that have hitherto been concealed into the open; it would give Gulf veterans an opportunity to be heard and to regain their confidence in the authorities; and, above all, it should prevent similar mistakes in the future.

Lord Clement-Jones: My Lords, it is difficult to add to the very powerful speeches that we have heard this evening. I start by paying tribute to the noble Lord, Lord Morris, and the all-party group for their tireless efforts on behalf of Gulf War veterans. On 24th March of last year we had a debate on this subject. Although I prepared for it I did not take part in the debate. I was unable to attend and my noble friend Lord Avebury spoke from these Benches. It is extraordinary how little progress has been made. I have looked carefully to see what has happened since then. I suspect that the Ministry of Defence takes the same approach. My noble friend received a letter from the Minister on 6th December purporting to answer questions raised in the debate on 24th March. That had a distinct lack of urgency about it. One wonders what resources are being devoted to attending to the issues and concerns of Gulf War veterans if even parliamentarians cannot receive replies to questions within what should be a few weeks rather than several months. I accept that, through the website, the Government have attempted to put more information into the public domain; indeed, in 1997 they adopted a more proactive stance. Yet I fear that their credit in this respect is rapidly running out.
	We need to keep reminding ourselves that behind the basic fears personal tragedies are being masked. As the noble Baroness, Lady Park, said, we are talking of 67 suicides. Some 5,000 of the 53,000 servicemen and women who served in the Gulf are reckoned to have been affected. Therefore, it is hardly surprising that there is such frustration among the veteran organisations. I understand that contact between them and the MoD has been broken off. I do not know whether it is temporary or is likely to last a long time, but it is unfortunate and must be the result of the handling of these issues by the MoD.
	The MoD claims that £2 million has been spent on research, yet the fruits of that research are limited. In addition to concern about the effects of the cocktail of vaccines mixed with the use of the organophosphates there is now concern that servicemen could have been exposed to depleted uranium. Again, there has been no real change since last year, except that protocols on the testing of urine sampled in Canada have been agreed.
	I looked at the research that is under way and it is very much the same as last year. There are few new avenues. We have seen research into low level exposure to organophosphates at the Institute of Public Health in Edinburgh and at Porton Down into the effect of vaccines on guinea pigs. Professor Nichola Cherry of Manchester University has carried out a study, the results of which are soon to be published. However, they have been due soon to be published for some time. Dr Hoyle of the London School of Hygiene and Tropical Medicine is carrying out research and Professor Glyn Lewis of the University of Wales is conducting a literature review. Neuromuscular research is being carried out by Drs Sharief and Rosa at King's College Medical School.
	However, should not the MoD be commissioning research which also includes the impact of stress? Has there been adequate research into biochemical causes in terms of the immune system? Why does not the MoD sponsor directly, or via the MRD, research into the way the human immune system is affected by vaccines and organophosphates? I see no willingness to undertake such research.
	Apart from the research there are other key questions. The Royal British Legion wants an independent public inquiry into Gulf War illnesses. But as the noble Countess, Lady Mar, in her powerful contribution said, the Government's response came after a long delay. Was that response adequate? Did the veterans receive a full response to their request for a public inquiry? They certainly did not. What compensation has been paid to date, other than through service pensions?
	A number of noble Lords raised the issue of medical records. I recognise that the MoD has attempted to give more information about them, but what resource is being applied to help the ex-servicemen find their records? It is not enough to say that there was some confusion, that some may have been lost and certain departments should be asked for the records. What resources are being devoted to that within those departments? Indeed, what lessons are being learnt for the future? I hope that this whole sorry episode, which has taken 10 years, will help the MoD to learn some lessons.
	I have a particular concern. Although there was little progress last year, one piece of maligned legislation was passed; that is, the Access to Justice Act. As legal aid has effectively been abolished for personal injury cases, it is unlikely that these claimants will receive legal aid. It is interesting that the latest MoD paper states that 1,817 claims have been notified to the department. These cases will not be suitable for legal aid, nor will they be suitable for conditional fee agreements because of the huge investigative cost involved. What assurance is there that in future claimants will be able to take action to obtain compensation? They seem to be caught in a catch-22 situation and under the funding code of the Legal Aid Board will not be eligible to take action.
	Therefore, the onus rests entirely with the claimants to establish legal liability. Despite what one might have thought were reasonably hopeful interim conclusions in the King's College study, there is no admission of legal liability showing that these ex-servicemen are more likely to become ill. These ex-servicemen are no ordinary litigants; they have given considerable service to their country. It is an outrage.
	The noble Lord, Lord Hoyle, who replied to the debate on 24th March, said that he believed that we were making real progress. I beg to differ. I ask the Minister, who is fresh to the issue, to take a new look at it. Perhaps with the Department of Health she will examine the whole issue to see whether other solutions are available. Will she recognise that in this respect we compare unfavourably with the United States and cede to the request of the Royal British Legion for an inquiry? I look forward to hearing her reply.

Earl Attlee: My Lords, I, too, am grateful to the noble Lord, Lord Morris of Manchester, for raising this important and sensitive issue once again. He is right to do so. I am a newcomer to the topic, but my noble friend Lord Burnham is an expert and I know that he works closely with the noble Lord, Lord Morris. Unfortunately, my noble friend cannot be here tonight. I remind the House that I have a potential interest in compensation and war pension issues.
	Servicemen engaging in operations are apprehensive on several counts. That which predominates will depend on the individual and the circumstances. Naturally, they will be concerned that they will meet the demands of the operation and perform to the utmost limits of their capability and not let down their comrades. There is hardly ever a problem here, which is why our country holds Her Majesty's Armed Forces in such high esteem.
	Then there are the perils of war: being killed, captured or physically or mentally injured by the enemy or by the environment of active service. However, the possibility of returning from an operation injured and permanently disabled must be at least as daunting as the other perils. We have heard tonight about fit servicemen going on operations and returning unfit and unable to look after their families as well as they would like or being unable to support themselves at all.
	Of course, we have war pension and compensation arrangements in place, but it is doubtful that any arrangements can put a disabled serviceman in as favourable a position as before he came to grief, not least, I suspect, because the Treasury would be reluctant to approve anything that was more than adequate.
	Another problem is that not all service careers progress at the same rate; hence the standard of living enjoyed and pensions earned will vary at the end of a full and successful career. It is extremely difficult to forecast how a career would have progressed. However, if we want our servicemen to prosecute an action to their maximum capability, they must be confident that they will be properly looked after if the worst happens. They should not have to fight for it post-conflict. At the very least, Gulf War illnesses are undermining that confidence and therefore, indirectly, to some extent our military capability.
	Noble Lords will therefore not be surprised that I have a great deal of sympathy for the Gulf War veterans. I believe that no stone must be left unturned in the search for the cause or causes of the illnesses. I am sure that the Minister will tell us what the MoD is doing about this.
	The noble Lord, Lord Morris, referred to the inquiries in the United States. I take it that the Minister will pay special attention to any conclusions from those inquiries. There is also the need to avoid duplication of research. There does not appear to be much risk of that as so few new studies are being funded by ourselves, as pointed out by many noble Lords.
	My noble friend Lady Park of Monmouth referred to the audit of MAP by the King's Fund. When I read the audit I thought that it was reporting on a large organisation. I then discovered the reality. Can the Minister confirm, as requested by my noble friend, that MAP funding at £750,000 has not been cut? Can she also say how many people work at MAP? Following on from the noble Countess, Lady Mar, is it true that technical reasons are not given by the MRC when it rejects a research proposal?
	The few noble Lords who have spoken tonight made excellent and well-informed speeches, but it is a pity that the debate has not been better attended. There has been much hysterical comment in the media about depleted uranium tank ammunition. They have been portrayed as almost mini-nuclear tipped weapons. The fact is that the extremely high density of the DU is used in order to increase the kinetic energy of the anti-tank round known as the armour piercing fin stabilised discarding sabot. Its long rod penetrator is only about one inch in diameter in order to reduce its wind resistance, which increases rapidly with its diameter. The increased weight due to the DU enables the round to penetrate the toughest armoured vehicles. It is therefore essential that this round is available in order to be able successfully to engage enemy vehicles. Can the Minister confirm that there is no consideration of withdrawing DU ammunition in the absence of a more effective alternative or firm evidence that it is not harmless to friendly troops?
	However, we do not know what is causing the Gulf War illnesses. Many hold that the DU is the cause, or part of it, either on its own or in combination with other factors. Over the past few days I have read much on the subject of testing for DU. Ministers have made it clear that DU testing is available if clinically indicated--in other words, if the doctors detect symptoms associated with DU or uranium poisoning. However, I have read the paper published in March last year entitled Testing for the Presence of Depleted Uranium in UK Veterans of the Gulf Conflict: The Current Position. From reading the paper it seems to me unlikely that any veterans will be displaying symptoms of DU or uranium poisoning and therefore no tests will be indicated. As the noble Countess, Lady Mar, put it, the absence of evidence is not evidence of absence.
	It is simply unsatisfactory to have a few individuals undertake tests privately in a non-structured way. When results which are not scientifically robust are submitted to the MoD, further controversy is created. However, I am not a scientist. I do not know how large samples and controls should be; neither do I know what the costs would be. However, I believe that it is essential that DU should be positively eliminated for individual veterans by an appropriate study, even if it is not clinically indicated.
	As regards the substantive Question tabled by the noble Lord, Lord Morris, regrettably I do not believe that the situation has changed since he asked a similar Unstarred Question last year. I do not think that a public inquiry would benefit anyone other than the lawyers and the printing and paper industry. The need is to identify the causes of the problem and not to find a scapegoat. I believe that it is far more important that the Minister leaves no stone unturned in the search for the cause or causes of Gulf War illnesses and also that she does everything in her power to ensure that servicemen adversely affected by operations are properly provided for.
	The noble Lord, Lord Clement-Jones, spoke about the lack of progress since our last debate. I hope that the Minister can explain what she and her colleagues are doing to achieve progress.

Baroness Symons of Vernham Dean: My Lords, I, too, am very grateful to my noble friend Lord Morris of Manchester for providing the opportunity to debate the Government's policy on Gulf veterans' illnesses and in particular to explain the Government's position on a public inquiry. I hope to respond to as many of the points raised this evening as I can, but I shall write if I am unable to cover in detail all the very many and important points that have been raised. The Government's approach to Gulf veterans' illnesses was set out in July 1997. Since then we have made considerable progress in delivering on the commitments we made. Perhaps I may assure all noble Lords who have participated in the debate, and others who I know are very interested in it, that responding to the concerns of those who participated in the Gulf conflict continues to be a very high priority for this Government.
	The present Minister of State for the Armed Forces, my honourable friend John Spellar, met representatives of the Gulf veterans soon after taking up his appointment. He has since visited the United States to discuss Gulf veterans issues with senior officials there. As the noble Countess, Lady Mar, remarked, that is a very important point given the number of American personnel who were involved.
	Under my honourable friend's direction the Gulf Veterans Illnesses Unit of the Ministry of Defence--the only central Ministry of Defence unit established to assist a discrete group of veterans--continues to oversee important research in this country and monitor that elsewhere, as the noble Baroness, Lady Park of Monmouth, said.
	In October last year the Government announced that it had decided that a public inquiry into Gulf veterans' issues at this time was not appropriate. That decision followed requests from the Royal British Legion and several other interested groups, including veterans' associations and parliamentarians. The noble Countess, Lady Mar, has certainly left us in no doubt about her disquiet concerning that decision. Therefore, I should like to explain the background to that decision.
	As the noble Lord, Lord Morris, said, there has been considerable scientific research on this issue, most notably in the United States, and there is a great deal of important research still under way. Despite that, an accepted cause for Gulf veterans' illnesses has not been found. As research results come through, we hope to rule out certain factors and so narrow down the scope for subsequent research. It is regrettable that much of that research is taking longer than we and the veterans themselves would like, but we cannot avoid the fact that robust scientific research is a time-consuming process. However, it is an essential process.
	The noble Lord, Lord Clement-Jones, dedicated much of his contribution to the issue of the research under way. Perhaps I may explain. The Government are funding two major epidemiological studies, one at Manchester University, to which a number of noble Lords have referred, and another at the London School of Hygiene and Tropical Medicine. I can assure the noble Baroness, Lady Park, that we expect the results from the Manchester research very soon. The Government are also funding research at King's College into the neuromuscular symptoms that some veterans have reported. Another study is being carried out into the interactions between the vaccines that were given prior to deployment to the Gulf. Those two studies are still ongoing. Altogether, we are investing £6 million in our portfolio of four substantial research projects.

Baroness Park of Monmouth: My Lords, will the Minister give way? Before the noble Baroness goes further, we need to make it plain that, as I understand it, we are seeking the inquiry not so much to discuss the research--nobody disputes the fact that ongoing research is a long-term strategic necessity--but what went wrong with the delivery of the necessary services, justice, (whatever one wishes to call it) to the Gulf War veterans. We need to know what can be done now to cure that situation. I believe that I am right in saying that that is what the inquiry was intended to be about.

Baroness Symons of Vernham Dean: My Lords, as I understand it, a number of reasons have been put forward as the argument for a public inquiry. One has been to discover whether or not there are illnesses that are associated with serving in the Gulf. Certainly, another has been to look at the way in which the whole issue has been handled. Another is to try to unearth whether there are lessons to be learned for the future. Therefore, although I accept that the noble Baroness is right that there is not one single trigger for the request for a public inquiry, I suggest that none the less the basis of what really happened to those serving in the Gulf is one of those factors adduced by those who have requested that such a public inquiry be undertaken. However, I hope to come to the point raised by the noble Baroness about the ways in which the whole issue has been handled.
	I return to the four research projects of which I spoke a moment or two ago. The information already available from the first part of the King's College study and from studies in the United States points to a very similar conclusion: that Gulf veterans report between two to three times more ill health than comparable groups. That does not constitute a single condition, nor unique illnesses among Gulf veterans. The same symptoms were also reported, but less frequently, by service personnel who have never been deployed to the Gulf and in those who were not in the Gulf conflict but who were involved in operations in Bosnia. There is also a hypothesis that war syndrome exists, arising from conflict generally. That has some quite strong support among experts.
	Through the Medical Research Council the Government already receive the best independent advice they can about how best to take forward research. In answer to the questions raised specifically by the noble Countess, Lady Mar, since 1997 seven full proposals have been received for research. Two have been accepted, but I stress to the noble Countess that those are not MoD decisions; they are decisions taken by the Medical Research Council independently of the MoD. The scientific feedback, including the reasons for rejection, is provided by the MRC in confidence to the applicants. Therefore, the MRC does not leave people guessing why specific research projects have been rejected.

The Countess of Mar: My Lords, I know of two cases where applications were made to the Medical Research Council--admittedly prior to this Government coming into office--when no reasons were given for the rejection of the research proposals, despite promises by the then Minister in this House that the applicants would receive them. The second point that I should like to raise with the Minister is that, in his King's College study, Professor Wessley found a correlation between vaccines and the increased incidence of reporting of ill health among the veterans. Yet, he appears to have chosen to ignore that in preference for a psychosomatic problem. What is the Ministry of Defence's attitude to that?

Baroness Symons of Vernham Dean: My Lords, on the latter point I shall have to write to the noble Countess. However, on her earlier point, the points that I was making to her relate to what has been the practice since 1997. If the noble Countess would be kind enough to tell me of any examples of practice before that date which are still cause for concern, I shall certainly look into the matter. However, as she will be aware, it is not the practice of governments always to look at what was done by previous administrations. Therefore, my ability to help her may be somewhat limited, but I undertake to do my best.
	Answers to questions about Gulf veterans' health can only be addressed by scientific and medical research. A public inquiry would have no better information before it than is currently available since all the research, both from the UK and worldwide, is published in journals which are available for everybody to see.
	There have been calls for a public inquiry into specific aspects of the Government's response to Gulf veterans' illness issues, one being a request for an inquiry into the Medical Assessment Programme which a number of your Lordships have mentioned this evening.
	Problems in the past with the Medical Assessment Programme are well known and understood. Indeed, the noble Countess, Lady Mar, detailed them for us in some detail and at some length. Those stem from the simple fact that in 1997 and 1998, we found it extremely difficult to recruit staff for the Medical Assessment Programme. We are fortunate now, however, to have in place two well-qualified and respected consultant physicians on a permanent basis.
	Perhaps I may say in answer to the specific questions about the Medical Assessment Programme that the funding for the Medical Assessment Programme has not been cut and, as I understand it, nine individuals are involved with the programme in total. There is no long waiting list. We are satisfied that that is the correct resourcing level for its functions.
	On 20th January 2000, a few days ago, the Government published their response to the audit of the Medical Assessment Programme. I believe that that was another question raised by a number of noble Lords and in particular the noble Countess, Lady Mar. The auditors were impressed by the enthusiasm and commitment of the staff, the organisation of the service and the evident commitment to the provision of a high quality service. The report also made a number of recommendations on how the organisation of the Medical Assessment Programme and the service it provides could be improved. Implementation of the audit recommendations will provide further improvements in the service of Gulf veterans.
	Other requests for an inquiry have focused on the issue of why the Government did not acknowledge earlier that some Gulf veterans were ill--a point raised by the noble Baroness, Lady Park, a few moments ago--in addition to the whole handling of the issues.
	The Government are well aware of the frustrations which arose because it appeared that action was not being taken soon enough. The Medical Assessment Programme was set up in 1993 under the previous administration soon after it became apparent that some UK Gulf veterans had health problems. The Royal College of Physicians audited the Medical Assessment Programme in 1995 and recommended epidemiological research and the Medical Research Council put that research in place during 1996.
	Significant shortcomings in the MoD's performance--for example, in medical record-keeping and in the handling of questions about organophosphate pesticides--have been acknowledged from 1995. Those issues, including the speed of the relevant MoD's response, have been and are being inquired into by the Defence Select Committee and in Parliament more generally. We believe that that is the most appropriate means of maintaining public scrutiny over this issue. We do not believe that to examine that further through a public inquiry would help us to understand more of what has gone on over and above what the Select Committee is already looking at. We certainly do not believe that it will help us to understand why the Gulf veterans were ill.
	We addressed also the issue of financial help for the Gulf veterans. No-fault compensation for service personnel disabled as a result of their service is already provided in the form of a war pension scheme. Ex-service personnel are also covered by the Armed Forces pension scheme--an occupational pension which, if veterans have been medically discharged, is supplemented by attributable benefits linked to the degree of disability or non-attributable benefits linked to the length of service, whichever is the greater. We have concluded that those two pension schemes are the appropriate methods for providing for disability among former service personnel.
	Having considered the matter very fully, the Government are not persuaded that on the basis of the information currently available to them, there is a case for paying additional no-fault compensation to Gulf veterans separate from and above that which is already available to both Gulf and other veterans. However, that will be kept under review in the light of developments. We have made clear that if legal liability is established by future research or investigation, the Government will of course pay common law compensation.
	As I have said, many of your Lordships will be aware that the Defence Committee is currently examining the Gulf veterans' illness issues. We believe that the Government's record is already a matter of close public scrutiny, both here and in another place. We believe that our current policy, our track record on delivering what we have promised and our continued openness allows for proper open assessment of what is being done. The Government believe that with hindsight, some of the things that were done at the time of the conflict should and could have been done better. I have spoken of medical record-keeping. The Government are determined to learn from the lessons of the past and we believe that this Administration have done so.
	For example, as my noble friend Lord Morris made clear in the paper published last week, the MoD has for the first time provided comprehensive information about the arrangements for the implementation of the anti-biological warfare immunisation programme. We pointed out that when we again deployed troops to protect Kuwait in 1998 during Operation BOLTON, we implemented those lessons.
	Our programme of anthrax vaccination was not classified. All troops received a detailed briefing on the vaccine, including the threat and the possible side-effects, to enable them to decide whether to be vaccinated. It is wrong to say that progress has not been made. The Government are trying to learn lessons from the past. We have been open in what we have put into the public domain.
	I entirely agree with the points made by the noble Lord, Lord Clement-Jones, about delays in correspondence. I was enormously disappointed to find those delays. I am making inquiries into why they arose.
	To my noble friend Lord Morris of Manchester I say that I shall be happy to look at any detailed cases that he wants to take up with me. A lot of information is coming out. Many noble Lords have referred to detailed statistics, including the number of deaths that have occurred since 1991. The most recent figure that I have is 413, although the noble Countess, Lady Mar, quoted 428. We need to look at the figures in the context of the Manchester study. Speculating now, as a number of noble Lords have done, about whether the rate of suicides is unusually high is premature when we shall have the findings of the Manchester study before us shortly.
	Questions were also raised by the noble Countess, Lady Mar, about our views on work with the United States. My honourable friend John Spellar has made a point of talking to our colleagues in the United States about the ways in which they handle such problems. We also have a full-time Gulf health liaison officer based in Washington who liaises closely with a number of US federal agencies. I should be happy to write on these issues to the noble Countess if she would find that helpful.
	I am trespassing on your Lordships' time, but a number of detailed questions have been raised. It is important not only for your Lordships but also for the Gulf veterans that I do my best to answer them. We are determined to learn from the lessons of the past and to maintain the momentum that we have achieved in dealing with this very important issue. The noble Baroness, Lady Park, was quite right. It is an issue of confidence not only among those who have served but also among those who are serving in our Armed Forces that they will be dealt with properly.
	To conclude, after careful consideration, we have taken note of the representations made since October 1999, but the Government believe that a public inquiry will simply not be able to answer the question of why Gulf veterans are ill. We hope that the other question raised by the noble Baroness and others about handling matters will be dealt with in greater detail by the Select Committee.
	Furthermore, assisting such an inquiry would divert resources away from the important work already under way that aims to answer the basic question of what happened to our troops in the Gulf. However, I stress that that decision reflects today's circumstances. Were circumstances to change, the possibility that a public inquiry may become appropriate is not excluded. That would depend on the evaluation of the circumstances at the time.

The Countess of Mar: My Lords, before the Minister sits down, I believe she was under a misapprehension about the audited amount. A management audit was carried out last year that has been reported on and to which the Ministry has now responded. A clinical audit was promised, but I do not know whether it has been carried out yet. It certainly has not reported yet. Will the Minister write to me on that?

Baroness Symons of Vernham Dean: My Lords, I shall be delighted to write to the noble Countess on that point. Of course, I shall put a copy of my letter in the Library of the House as I know that many noble Lords are interested in the subject.

House adjourned at twenty-five minutes past nine o'clock.